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Massachusetts 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
$2,528.00 / $2,894.76 / $6,617.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.10 / $4,916.00 / $17,305.08
AllWays Health Partners
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$287.36 / $287.36 / $2,569.69
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,758.44 / $8,090.00
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,861.93 / $6,110.08 / $26,355.72
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,097.00 / $13,773.00
Mass General Brigham
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$287.36 / $287.36 / $2,569.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $10,764.00