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Oregon 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
$1,348.96 / $2,570.40 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,258.93 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,187.76 / $3,162.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,949.84 / $2,570.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,737.80 / $2,754.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $2,691.53
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,995.26 / $2,041.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,513.56 / $2,454.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,949.84 / $2,818.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,187.76 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $10,232.93 / $37,153.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,995.26 / $2,884.03