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Utah rates for HCPCS 50574

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $602.56 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $776.25 / $1,148.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,258.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $6,025.60 / $13,489.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,071.52 / $1,258.93
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $1,023.29 / $1,479.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $891.25 / $1,230.27
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
$537.03 / $676.08 / $1,174.90