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West Virginia 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
$676.08 / $676.08 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $707.95 / $1,230.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $912.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,258.93