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New Hampshire rates for HCPCS 50957

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,452.68 / $8,965.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.91 / $512.02 / $1,452.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.47 / $616.25 / $888.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.58 / $851.75 / $1,424.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.02 / $820.02 / $1,489.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,565.00 / $9,565.00 / $9,565.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.69 / $853.67 / $1,716.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.58 / $339.19 / $407.03