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Wisconsin rates for HCPCS 52355

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.99 / $943.40 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,479.00 / $9,096.00 / $15,579.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,177.76 / $1,376.31 / $2,219.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.99 / $642.04 / $2,323.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.99 / $2,323.85 / $8,783.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.99 / $642.04 / $2,323.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.90 / $1,391.13 / $1,895.12
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,302.50 / $14,302.50 / $14,302.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,103.00 / $6,477.00 / $8,384.00