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Maryland rates for HCPCS 50075

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,659.59 / $4,570.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,621.81 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,905.46 / $4,168.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,548.82 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $2,951.21
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,737.80 / $2,041.74