go back

Maryland 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
$3,311.31 / $7,079.46 / $22,387.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,202.26 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03