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Missouri 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
$1,664.88 / $4,470.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.08 / $1,650.65 / $1,685.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,490.00 / $11,288.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,460.75 / $1,789.92 / $2,860.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.59 / $2,076.58 / $3,810.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.00 / $2,276.09 / $7,903.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,634.72 / $2,647.18 / $10,796.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.00 / $2,693.00 / $10,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,519.37 / $2,036.69 / $3,983.53