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Arizona rates for HCPCS 50957

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.00 / $2,736.07 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.09 / $409.08 / $1,858.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.60 / $1,640.88 / $2,700.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.83 / $324.58 / $403.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,645.45 / $4,645.45 / $4,645.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.98 / $477.06 / $875.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.23 / $491.83 / $3,339.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.40 / $558.00 / $5,828.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,343.00 / $3,339.00 / $5,838.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.63 / $476.91 / $835.72