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Alaska rates for HCPCS 50130

Pyelotomy With Removal Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,064.55 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,846.59 / $4,846.59 / $6,735.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,568.55 / $3,568.55 / $3,568.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.03 / $4,846.59 / $6,930.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,502.00 / $6,497.40 / $8,510.26
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,867.50 / $4,486.30 / $6,586.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.03 / $4,846.59 / $6,930.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,418.83 / $4,474.50 / $6,661.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,611.08 / $4,282.26 / $6,592.21