go back

Utah 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
$1,023.29 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $758.58 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,737.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $8,511.38 / $19,952.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,348.96 / $5,011.87
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,288.25 / $1,862.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,479.11