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Georgia 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
$1,202.26 / $5,623.41 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $3,801.89 / $6,918.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,096.48 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,148.15 / $1,819.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $6,918.31 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $977.24 / $1,778.28