go back

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
$2,089.30 / $4,365.16 / $10,715.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $8,317.64 / $23,988.33
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,365.16 / $11,220.18 / $36,307.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,570.40 / $7,413.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,848.93 / $20,892.96 / $29,512.09
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$23,988.33 / $34,673.69 / $44,668.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $22,387.21 / $27,542.29