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Pennsylvania 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
$1,047.13 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,096.48 / $2,691.53
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,318.26 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,288.25 / $2,041.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,412.54 / $1,548.82
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $1,995.26
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $8,511.38 / $8,511.38
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,318.26 / $2,951.21
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $2,041.74
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $2,137.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,202.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,000.00 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $2,089.30