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Utah rates for HCPCS 50572

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $575.44 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $724.44 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,174.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,122.02 / $2,630.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,000.00 / $1,202.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $954.99 / $1,380.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $831.76 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,818.38 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $1,096.48