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Missouri 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
$1,174.90 / $4,786.30 / $8,511.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $1,584.89 / $11,220.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,801.89 / $8,709.64