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Massachusetts 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
$1,071.52 / $3,388.44 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $3,235.94
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $2,454.71 / $7,244.36
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,513.56 / $7,585.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,905.46 / $3,630.78
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $1,548.82 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,071.52 / $1,584.89
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $3,311.31 / $5,888.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,698.24 / $2,454.71
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $2,454.71 / $7,244.36
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,513.56 / $7,585.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,884.03 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,548.82 / $2,884.03