go back

Minnesota 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
$977.24 / $977.24 / $977.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,148.15 / $1,905.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $8,317.64 / $22,908.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,290.87 / $3,715.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,715.35 / $8,912.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,162.28 / $4,786.30
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,548.13 / $6,918.31
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,691.53 / $3,981.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,905.46 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,089.30 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,467.37 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,089.30 / $4,073.80