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Wyoming 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
$706.52 / $706.52 / $706.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,373.00 / $1,648.00 / $2,060.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.96 / $1,175.22 / $1,678.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.90 / $1,816.03 / $2,801.05