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South Carolina 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
$1,258.93 / $7,943.28 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,122.02 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,318.26 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,380.38 / $2,344.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,513.56 / $2,398.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $6,760.83 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $2,137.96