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Indiana rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,344.23 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,000.00 / $1,778.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $19,054.61 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $1,995.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $954.99 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,202.26 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $5,754.40 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,096.48 / $1,778.28