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Texas 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
$1,148.15 / $4,168.69 / $12,589.25
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $12,882.50 / $25,118.86
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $3,801.89 / $6,606.93
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $9,120.11 / $9,120.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $6,918.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $26,915.35
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,995.26 / $7,413.10
Moda Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$11,220.18 / $11,220.18 / $11,220.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,659.59 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $6,918.31 / $14,454.40