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Washington, DC 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
$1,096.48 / $2,137.96 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,122.02 / $3,235.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,318.26 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,380.38 / $2,951.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,000.00 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $2,344.23 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,288.25 / $2,511.89