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West 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
$1,205.93 / $1,205.93 / $2,600.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,193.22 / $1,324.57 / $1,443.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.86 / $1,277.86 / $1,277.86
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$124.67 / $124.67 / $124.67
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,771.81 / $18,328.65 / $47,085.86