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Michigan rates for HCPCS 50580

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $645.65 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,348.96 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $707.95 / $1,000.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $2,041.74 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $707.95 / $1,000.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $707.95 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,981.07 / $11,481.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $776.25 / $1,047.13