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Indiana 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
$649.82 / $5,354.00 / $19,598.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,575.00 / $24,214.00 / $45,778.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.80 / $951.26 / $1,426.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,405.61 / $6,405.61 / $6,405.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,699.00 / $9,550.00 / $15,750.00