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South Carolina 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
$3,517.36 / $9,062.00 / $15,652.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,062.08 / $10,479.10 / $18,498.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,081.57 / $6,081.57 / $7,814.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,245.79 / $1,713.91 / $2,714.50
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,394.00 / $2,588.42 / $3,580.17
Medcost
Facility/Professional
Facility
Modifier
80
Low / Median / High Price
$319.20 / $345.12 / $477.36
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$211.92 / $241.59 / $334.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,959.00 / $23,485.00