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Louisiana 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
$933.25 / $2,691.53 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,011.87 / $10,964.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,412.54 / $1,698.24
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,348.96 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $1,230.27 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,174.90 / $1,905.46