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Washington, DC 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
$1,614.00 / $5,909.00 / $6,996.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,909.00 / $5,909.00 / $5,909.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.88 / $2,501.94 / $2,501.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $4,165.00 / $26,408.00