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Pennsylvania rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,011.14 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.44 / $944.93 / $1,203.60
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.34 / $1,330.57 / $1,782.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$914.64 / $1,223.19 / $1,924.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.59 / $1,460.14 / $1,464.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.44 / $1,005.53 / $2,843.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,212.40 / $2,349.69
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$924.24 / $1,236.14 / $1,982.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.58 / $920.58 / $1,088.58
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.53 / $925.25 / $1,088.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $2,391.00 / $6,322.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.56 / $1,179.26 / $1,910.51