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Nationwide rates for HCPCS 50575

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $4,466.84 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $794.33 / $1,621.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $5,128.61 / $13,803.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,000.00 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,995.26 / $5,011.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,096.48 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $7,244.36 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $912.01 / $1,659.59