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Hawaii rates for HCPCS 50075

Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,747.00 / $2,747.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.46 / $1,565.76 / $1,565.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,439.26 / $1,779.96 / $1,785.88
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.09 / $2,395.63 / $8,902.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,566.37 / $1,708.76 / $1,993.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,446.00 / $2,446.00 / $2,446.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,452.45 / $1,779.96 / $2,320.94
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $1,499.19 / $2,371.23