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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
$723.00 / $5,045.00 / $8,331.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.27 / $847.22 / $1,640.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.20 / $4,415.29 / $8,702.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.25 / $1,046.36 / $1,982.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.94 / $1,450.83 / $2,228.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,185.25 / $3,185.25 / $3,185.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.57 / $1,197.42 / $1,995.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.34 / $896.14 / $2,034.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,738.00 / $7,794.00 / $14,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.29 / $1,098.61 / $1,842.61