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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)

Facilitymedian $5,495 · 10th–90th $1,072–$10,0000%10%10th90th$5,495$1.0K$2.0K$5.0K$10.0K$20.0K$50.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $5,495.41 / $10,000.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,549.93 / $10,000.00 / $57,543.99
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16,595.87 / $20,892.96 / $87,096.36
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $4,265.80 / $8,511.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,096.48 / $1,258.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $30,199.52