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Washington 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
$1,110.56 / $7,920.26 / $27,982.24
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.10 / $26,091.73 / $49,939.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,795.54 / $6,795.54 / $11,321.29
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.08 / $1,958.77 / $11,682.66
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,143.45 / $1,431.84 / $1,753.04
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.10 / $1,148.81 / $4,273.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,928.99 / $26,091.73 / $49,939.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $3,509.00 / $17,644.00