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New York 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
$1,058.38 / $5,576.00 / $11,690.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,989.00 / $9,720.00 / $20,926.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,225.36 / $1,225.36 / $12,319.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.47 / $791.47 / $7,227.90
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $1,189.43 / $2,384.00
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $791.47 / $7,227.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,337.00 / $6,450.00 / $12,742.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.24 / $900.24 / $3,012.18