go back

Utah 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
$870.96 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $645.65 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $831.76 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,348.96
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
$776.25 / $1,148.15 / $1,348.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $1,096.48 / $1,584.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $724.44 / $1,258.93