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Virginia 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
$463.47 / $2,561.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.67 / $418.80 / $506.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,153.00 / $7,363.00 / $9,410.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.15 / $455.97 / $660.58
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.77 / $552.66 / $7,369.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.01 / $533.80 / $967.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.60 / $495.12 / $610.65
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.49 / $537.08 / $794.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.00 / $621.00 / $822.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.90 / $480.76 / $3,512.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.56 / $601.25 / $3,512.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,349.00 / $7,061.00 / $12,739.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.70 / $603.13 / $941.12