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Indiana rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$884.31 / $1,113.24 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.31 / $944.93 / $1,246.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,091.00 / $15,580.56 / $24,062.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.88 / $1,257.40 / $1,735.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$917.20 / $1,294.88 / $1,942.32
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.41 / $1,122.23 / $1,553.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.67 / $1,250.09 / $2,050.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $5,242.00 / $10,843.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.51 / $1,123.67 / $1,862.71