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Utah 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
$602.56 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $436.52 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $537.03 / $794.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $691.83
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
$501.19 / $724.44 / $933.25
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $676.08 / $891.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $588.84 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $457.09 / $758.58