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Missouri 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
$1,340.12 / $5,752.00 / $8,845.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$917.34 / $1,916.15 / $8,361.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$287.36 / $2,569.69 / $2,569.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,039.00 / $10,781.00