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Massachusetts 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
$724.44 / $3,090.30 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $758.58 / $2,238.72
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,897.79 / $13,803.84
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $1,047.13 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,288.25 / $2,454.71
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $1,023.29 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $707.95 / $1,071.52
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,202.26 / $1,949.84
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,011.87 / $13,803.84
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $1,047.13 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,489.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,122.02 / $2,754.23