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Maryland rates for HCPCS 50130

Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,174.90 / $3,235.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,174.90 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,348.96 / $2,951.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,122.02 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,230.27 / $2,089.30
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,258.93 / $1,479.11