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Maine rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,148.15 / $2,137.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,197.01 / $19,498.45 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,445.44 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,288.25 / $2,089.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,288.25 / $1,862.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $2,951.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $1,862.09