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South Carolina 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
$849.06 / $9,062.00 / $17,872.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,789.10 / $10,586.52 / $18,498.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,081.57 / $6,081.57 / $7,814.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$846.63 / $1,151.71 / $1,724.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,959.00 / $23,485.00