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Texas 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
$1,000.00 / $3,715.35 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,122.02 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,819.70 / $4,466.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $1,621.81
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $2,187.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $9,332.54
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $8,511.38 / $8,511.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,445.44 / $4,073.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,258.93 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $138.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $1,949.84 / $2,570.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,380.38 / $2,344.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $2,454.71 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,174.90 / $1,819.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $954.99 / $954.99