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Idaho 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
$3,422.00 / $5,519.00 / $8,622.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.58 / $1,548.78 / $2,087.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,480.23 / $22,875.82 / $28,539.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,120.00 / $22,317.00 / $27,159.00