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Vermont 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
$1,967.51 / $1,967.51 / $7,660.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.39 / $2,395.01 / $5,127.57
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.10 / $2,400.61 / $5,127.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.95 / $2,066.46 / $6,293.52