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Arizona 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
$2,100.00 / $4,521.00 / $9,196.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,211.19 / $3,616.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,805.45 / $8,805.45 / $8,805.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.74 / $1,574.50 / $7,168.00
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$287.36 / $2,569.69 / $2,569.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,477.00 / $9,010.00