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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
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $891.25 / $1,621.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,754.40 / $13,489.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,122.02 / $1,380.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,380.38 / $2,290.87
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,174.90 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $11,748.98 / $16,218.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,122.02 / $1,348.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,230.27 / $12,302.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $22,387.21 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,479.11