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Rhode Island 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
$3,715.35 / $3,981.07 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,258.93 / $3,235.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,071.52 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $1,348.96 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,548.13 / $7,244.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,318.26 / $2,041.74