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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
$1,942.62 / $3,940.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,405.30 / $1,791.07 / $1,942.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.00 / $2,387.00 / $4,232.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.45 / $1,826.88 / $3,255.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,405.81 / $2,037.65 / $3,200.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $13,210.64 / $13,513.44
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,555.60 / $10,796.64 / $12,029.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,249.00 / $2,698.00 / $4,626.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.17 / $2,172.84 / $3,315.33