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Maryland 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
$820.96 / $5,834.83 / $9,649.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,040.18 / $5,040.18 / $5,040.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.82 / $954.70 / $1,754.63