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Michigan 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
$891.25 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $758.58 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,584.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,047.13 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,174.90
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $2,137.96 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $1,122.02
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $851.14 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $7,413.10 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $912.01 / $1,230.27