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Michigan 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
$1,846.49 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,354.80 / $1,846.49 / $1,846.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,908.88 / $8,052.54 / $10,909.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.99 / $2,166.21 / $3,614.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,344.96 / $1,678.98 / $2,973.20
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.03 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.03 / $1,638.76 / $2,383.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.87 / $1,265.49 / $1,892.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,713.00 / $4,056.00 / $6,036.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,612.58 / $1,969.37 / $2,536.79