go back

Michigan 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
$1,428.80 / $5,757.00 / $11,016.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,402.83 / $12,143.24 / $16,542.43
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,643.94 / $7,659.41 / $10,787.11
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.26 / $5,757.00 / $9,904.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,069.00 / $8,847.00 / $10,652.00