go back

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
$728.85 / $2,747.00 / $5,454.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.70 / $732.45 / $1,758.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.35 / $4,916.00 / $12,729.53
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.71 / $1,398.16 / $5,126.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.47 / $1,410.19 / $2,555.83
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,096.05 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.28 / $807.42 / $1,276.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.67 / $1,724.50 / $2,600.94
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,097.00 / $13,773.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.03 / $1,461.40 / $5,126.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $10,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.70 / $1,140.11 / $2,569.71