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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
$2,187.76 / $5,011.87 / $9,120.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,778.28 / $2,691.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,905.46 / $8,128.31
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$288.40 / $2,570.40 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $6,918.31 / $8,709.64