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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
$1,461.21 / $7,068.88 / $12,332.18
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,304.20 / $8,304.20 / $8,304.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,040.18 / $5,040.18 / $5,040.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,151.83 / $1,531.95 / $2,575.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,882.00 / $2,882.00 / $2,882.00