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Pennsylvania rates for HCPCS 50955

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.17 / $2,070.00 / $7,799.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.56 / $377.71 / $538.24
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.78 / $541.29 / $789.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.47 / $523.04 / $807.90
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.78 / $664.19 / $670.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.00 / $2,326.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.37 / $419.67 / $1,541.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $970.30 / $1,075.40
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.59 / $524.03 / $828.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.28 / $342.31 / $991.08
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.28 / $402.10 / $435.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.23 / $563.10 / $895.96