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Arkansas rates for HCPCS 50130

Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,698.24 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,174.90 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,621.81 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $1,071.52 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,071.52 / $1,949.84