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Arizona rates for HCPCS 50080

Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,671.00 / $4,474.00 / $7,960.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,197.38 / $3,616.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,805.45 / $8,805.45 / $8,805.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.49 / $1,052.96 / $7,167.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,477.00 / $9,010.00