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Illinois rates for HCPCS 50081

Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $5,128.61 / $10,715.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,079.46 / $13,803.84 / $26,915.35
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,862.09 / $6,309.57
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $6,918.31 / $12,882.50