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Texas 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
$921.00 / $3,617.00 / $12,258.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,615.70 / $12,424.61 / $24,365.15
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.52 / $9,724.24 / $9,724.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $6,860.97 / $6,860.97
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $27,110.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.86 / $1,138.74 / $2,057.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.86 / $1,150.54 / $2,183.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00