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New Jersey 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
$2,754.23 / $7,943.28 / $12,022.64
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$12,022.64 / $12,589.25 / $12,589.25
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,620.87 / $29,512.09 / $46,773.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $9,120.11 / $21,379.62