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Idaho 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 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,348.96 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,981.07 / $4,897.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,995.26 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,659.59 / $1,995.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $2,089.30 / $3,311.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,778.28 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,659.59 / $1,995.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $15,488.17 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,445.44 / $2,137.96