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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
$1,819.70 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,348.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,370.32 / $9,332.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $977.24 / $1,445.44
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $14,454.40 / $14,454.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,888.44 / $5,888.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $5,754.40 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,548.82