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Nebraska 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
$5,097.25 / $8,477.27 / $20,928.72
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$11,400.00 / $11,400.00 / $11,400.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,823.60 / $13,313.50 / $24,992.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.33 / $2,135.38 / $13,688.88
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$2,569.69 / $2,569.69 / $2,569.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,080.04 / $2,996.13 / $8,958.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00