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Oklahoma 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
$1,456.00 / $5,538.00 / $18,600.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,721.40 / $12,180.59 / $19,381.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.32 / $1,959.73 / $8,753.15
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$2,569.69 / $2,569.69 / $2,569.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,407.00 / $9,232.95