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Utah 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
$1,479.11 / $4,168.69 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,122.02 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,412.54 / $2,238.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,511.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,949.84 / $3,715.35
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,905.46 / $2,691.53
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,202.26 / $2,137.96