go back

Hawaii 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
$1,924.00 / $5,484.00 / $6,718.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.30 / $827.23 / $965.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00