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New Jersey 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
$4,265.80 / $6,456.54 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $758.58 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,023.29 / $2,398.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $1,174.90
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $16,218.10 / $25,703.96
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $794.33 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $9,120.11 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $707.95 / $1,548.82