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West Virginia 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
$812.83 / $8,128.31 / $8,128.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $1,174.90 / $1,174.90
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $18,620.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $26,302.68