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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
$586.75 / $5,695.00 / $10,871.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.75 / $766.17 / $1,197.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.05 / $1,072.85 / $2,258.65
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.54 / $1,078.54 / $1,289.89
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,973.98 / $9,973.98 / $21,935.56
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.54 / $756.98 / $1,257.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,682.00 / $9,969.00 / $19,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.00 / $743.82 / $1,605.43