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Minnesota 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
$660.69 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $758.58 / $1,318.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $9,772.37 / $23,442.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,584.89 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,511.89 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,137.96 / $3,235.94
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,398.83 / $4,677.35
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,819.70 / $2,754.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,380.38 / $10,964.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,445.44 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $8,709.64 / $13,489.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,445.44 / $2,754.23