go back

Tennessee 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
$1,621.96 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.27 / $811.33 / $950.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,531.00 / $4,657.00 / $7,782.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.36 / $909.06 / $1,610.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.23 / $1,008.28 / $1,561.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,302.50 / $14,302.50
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,126.08 / $5,240.88 / $5,831.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,799.00 / $5,728.00 / $10,111.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.51 / $997.85 / $1,693.76