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Utah rates for HCPCS 50125

Pyelotomy; with drainage, pyelostomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,380.38 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,511.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,862.09 / $2,187.76
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,778.28 / $2,570.40
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,548.82 / $2,137.96
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
$933.25 / $1,174.90 / $2,041.74