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Idaho 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
$4,415.00 / $5,519.00 / $13,847.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,271.40 / $2,504.61 / $3,070.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,480.23 / $22,875.82 / $28,539.36
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$12,096.96 / $34,313.73 / $43,527.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,120.00 / $22,317.00 / $27,159.00