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Indiana 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
$1,148.15 / $2,344.23 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,096.48 / $1,949.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $19,054.61 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $2,187.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,047.13 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,318.26 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $5,754.40 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $1,949.84