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Alaska rates for HCPCS 50075

Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,330.32 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,848.41 / $6,848.41 / $9,534.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,052.50 / $5,052.50 / $5,052.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,836.48 / $6,848.41 / $9,793.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,517.68 / $9,135.00 / $12,022.21
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,437.50 / $6,307.50 / $9,295.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,836.48 / $6,848.41 / $9,793.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.18 / $6,315.00 / $9,394.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,675.62 / $6,063.00 / $9,332.11