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Alaska 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
$2,125.71 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.45 / $3,361.82 / $3,741.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,496.71 / $2,496.71 / $2,496.71
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.46 / $3,361.82 / $4,807.39
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.08 / $4,433.10 / $5,892.71
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,638.75 / $3,060.95 / $4,562.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.46 / $3,361.82 / $4,807.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.30 / $3,096.00 / $4,611.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.11 / $2,996.07 / $4,618.12