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Alaska 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
$3,350.22 / $9,813.00 / $17,617.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,419.27 / $5,298.37 / $7,576.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,419.27 / $5,298.37 / $7,576.67