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South Carolina 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
$870.96 / $7,943.28 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $758.58 / $1,584.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $7,943.28 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $912.01 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $977.24 / $1,621.81
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $17,378.01 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,479.11