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Massachusetts 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
$1,479.11 / $3,388.44 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,584.89 / $4,570.88
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $3,311.31 / $7,244.36
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,137.96 / $10,471.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,691.53 / $5,011.87
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $2,089.30 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,479.11 / $2,238.72
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $3,311.31 / $5,888.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,344.23 / $3,467.37
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $3,311.31 / $7,244.36
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,137.96 / $10,471.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,884.03 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,187.76 / $4,073.80