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Florida 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
$1,047.13 / $5,495.41 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $741.31 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $2,511.89 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $977.24 / $1,659.59
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $12,022.64 / $22,908.68
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $489.78 / $831.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $10,232.93 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $870.96 / $1,513.56
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $645.65