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Pennsylvania 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
$976.00 / $4,676.00 / $10,883.30
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,142.42 / $18,524.91 / $88,091.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $4,832.00 / $10,011.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.54 / $676.54 / $1,098.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,914.00 / $7,000.00