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Utah rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,023.29 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,288.25 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,089.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,778.28 / $2,089.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,737.80 / $2,454.71
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,513.56 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $1,995.26