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Pennsylvania rates for HCPCS 50575

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.25 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.69 / $732.45 / $901.63
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.55 / $994.13 / $1,349.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.89 / $930.45 / $1,453.69
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.40 / $1,079.86 / $1,079.86
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.69 / $752.25 / $1,806.53
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $962.10 / $1,736.60
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.13 / $940.38 / $1,633.76
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.80 / $687.80 / $993.91
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.97 / $693.00 / $993.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,914.00 / $7,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.72 / $881.07 / $1,463.18