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Vermont 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
Professional
Modifier
Low / Median / High Price
$724.44 / $912.01 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $977.24 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,071.52 / $2,951.21