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Minnesota 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
$659.97 / $659.97 / $8,339.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,495.18 / $15,157.95 / $32,738.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,676.11 / $2,376.92 / $5,718.02
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,362.55 / $2,173.08 / $4,502.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,070.01 / $1,394.25 / $10,878.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,940.00 / $8,689.00 / $11,531.00