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Texas rates for HCPCS 50130

Pyelotomy With Removal Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.00 / $3,596.00 / $10,836.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.89 / $1,086.95 / $1,505.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,039.00 / $1,743.91 / $4,996.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$935.40 / $1,183.99 / $1,649.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$911.12 / $911.12 / $911.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.35 / $1,388.96 / $2,146.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $9,397.76
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,505.04 / $7,669.52 / $8,560.73
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.04 / $1,350.56 / $2,284.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.88 / $1,531.22 / $1,801.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.00 / $1,493.00 / $1,493.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.04 / $1,365.14 / $2,445.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.35 / $1,410.28 / $2,238.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.00 / $2,000.00 / $8,759.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.24 / $1,184.21 / $1,830.14
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.15 / $978.43 / $1,350.95