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Indiana 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
$1,173.00 / $12,411.48 / $16,857.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,575.00 / $24,214.00 / $45,778.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.69 / $1,529.91 / $2,294.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,405.61 / $6,405.61 / $6,405.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,699.00 / $9,550.00 / $15,750.00