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Ohio 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
$1,502.37 / $6,832.00 / $11,243.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,097.00 / $8,010.00 / $36,529.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.44 / $790.13 / $1,234.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,690.76 / $3,690.76 / $9,535.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,206.00 / $6,578.00 / $10,075.00