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Rhode Island 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
$3,715.35 / $3,981.07 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $870.96 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $741.31 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $933.25 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $7,413.10 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,000.00 / $1,380.38