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Colorado 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
$3,090.30 / $5,370.32 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $812.83 / $1,621.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $11,481.54 / $23,988.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,000.00 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $1,445.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $891.25 / $2,511.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $12,022.64 / $20,417.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $1,862.09