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California 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
$4,168.69 / $10,471.29 / $23,988.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $8,128.31 / $15,848.93
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $4,786.30 / $20,417.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $7,079.46
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $954.99 / $1,445.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $2,344.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$501.19 / $501.19 / $501.19
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $26,915.35
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,621.81 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $12,302.69 / $25,703.96