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Idaho 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
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.45 / $918.29 / $1,611.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.28 / $1,224.47 / $1,367.04
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$797.54 / $1,422.88 / $1,708.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.67 / $1,194.95 / $1,365.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $987.32 / $1,242.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,064.64 / $12,228.99 / $15,681.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.61 / $1,072.61 / $1,326.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,120.00 / $22,317.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.91 / $979.48 / $1,527.36