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Kentucky 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
$687.65 / $1,156.47 / $9,311.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,755.00 / $8,584.00 / $11,253.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.44 / $902.82 / $1,041.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.47 / $791.47 / $973.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.00 / $4,539.00 / $10,069.00