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Arizona 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
$2,041.74 / $3,890.45 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $794.33 / $1,949.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $5,370.32 / $7,943.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $645.65 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $4,677.35 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,513.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,071.52 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $5,888.44 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $776.25 / $1,380.38