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California 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
$4,466.84 / $10,471.29 / $22,908.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $5,495.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $10,715.19 / $17,782.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,659.59 / $3,235.94
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $100.00 / $6,025.60
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,479.11 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $2,818.38
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,047.13 / $1,258.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,148.15 / $2,041.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $9,332.54
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $8,511.38 / $8,511.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,380.38 / $2,089.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $2,691.53
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $6,165.95 / $18,620.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,258.93 / $2,884.03