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New Hampshire 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
$1,513.56 / $4,168.69 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,096.48 / $3,235.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $15,488.17 / $24,547.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $2,089.30 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,949.84 / $3,467.37
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,698.24 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,698.24 / $3,090.30