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Tennessee 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
$1,389.14 / $5,102.00 / $30,399.55
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,794.00 / $1,794.00 / $1,794.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,430.00 / $7,194.00 / $13,498.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $27,110.45 / $27,110.45
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$287.36 / $2,569.69 / $2,569.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,271.00 / $5,605.00 / $10,104.00