go back

Maine 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
$1,047.13 / $1,258.93 / $2,290.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,197.01 / $19,498.45 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,584.89 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,412.54 / $2,290.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $2,041.74
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,412.54 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,479.11 / $2,041.74