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Wisconsin 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
$707.95 / $1,445.44 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $724.44 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $17,378.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,348.96 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,089.30 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $2,238.72 / $2,511.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $2,570.40 / $4,786.30
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,737.80 / $2,137.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $7,585.78 / $15,848.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,288.25 / $5,248.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $954.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,584.89 / $2,691.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $14,454.40 / $14,454.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $3,467.37 / $5,128.61
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $4,168.69 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $12,302.69 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,148.15 / $3,019.95