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Washington, DC 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
$1,412.54 / $5,128.61 / $6,918.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $691.83 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $16,218.10 / $45,708.82