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Tennessee 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
$2,398.83 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,659.59 / $2,754.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,454.71 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,137.96 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,949.84 / $2,951.21
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $13,182.57 / $13,182.57
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,471.29 / $12,022.64 / $12,022.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,630.27 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,995.26 / $3,162.28