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Virginia 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
$1,584.89 / $5,495.41 / $20,892.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $14,791.08 / $15,848.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,202.26 / $3,019.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,041.74 / $2,951.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,778.28 / $2,630.27
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,698.24 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $11,748.98 / $23,988.33