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Michigan rates for HCPCS 50130

Pyelotomy With Removal Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,309.77 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.69 / $1,309.77 / $1,309.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,851.51 / $5,663.17 / $7,714.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.93 / $1,540.75 / $2,570.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.86 / $1,190.25 / $2,108.71
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,046.38 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.38 / $1,163.91 / $1,786.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.78 / $902.12 / $1,341.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.00 / $4,645.00 / $6,327.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.63 / $1,374.04 / $1,763.12