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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
$1,491.16 / $5,973.74 / $12,592.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,989.00 / $9,720.00 / $20,926.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.53 / $1,800.53 / $12,319.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.86 / $26,553.00 / $31,991.00
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$124.67 / $124.67 / $124.67
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $1,715.00 / $8,640.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,780.80 / $8,983.37 / $18,122.75
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $7,227.90 / $31,991.00
MVP Health Care
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$124.67 / $124.67 / $124.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,337.00 / $6,450.00 / $12,742.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.15 / $1,449.15 / $4,423.43