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Pennsylvania rates for HCPCS 50130

Pyelotomy With Removal Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$913.97 / $1,026.84 / $1,309.77
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.85 / $1,447.54 / $1,938.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$993.83 / $1,330.49 / $2,094.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.50 / $1,585.51 / $1,590.52
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$913.97 / $1,093.21 / $2,843.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,311.00 / $2,553.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.86 / $1,343.16 / $2,131.85
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,001.50 / $1,001.50 / $1,210.41
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.73 / $1,006.84 / $1,210.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $2,391.00 / $6,322.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.39 / $1,360.84 / $2,182.81