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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
$1,671.00 / $3,437.00 / $6,329.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.70 / $732.45 / $3,741.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,598.50 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.98 / $579.97 / $724.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,645.45 / $4,645.45 / $4,645.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.56 / $874.78 / $1,570.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.26 / $972.08 / $7,167.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.82 / $844.19 / $5,240.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.79 / $793.94 / $1,365.96