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New York 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
$1,479.11 / $6,025.60 / $13,182.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $11,220.18 / $23,442.29
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $12,302.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $28,183.83 / $33,884.42
Cigna
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$190.55 / $190.55 / $190.55
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,737.80 / $6,918.31
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,918.31 / $12,302.69
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $50,118.72 / $75,857.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,888.44 / $15,135.61
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,445.44 / $4,365.16