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Virginia rates for HCPCS 50130

Pyelotomy With Removal Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,171.63 / $4,771.00 / $9,539.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$973.38 / $1,171.63 / $1,278.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,671.00 / $14,927.78 / $20,791.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.41 / $1,207.69 / $1,656.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.57 / $1,382.46 / $2,406.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.91 / $1,384.66 / $2,569.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.93 / $1,174.72 / $1,448.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,109.01 / $1,439.24 / $2,000.57
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.00 / $1,440.00 / $2,400.91
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,016.43 / $1,385.36 / $2,476.48
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.43 / $1,385.36 / $2,476.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,547.00 / $3,130.00 / $5,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$885.70 / $1,382.31 / $2,235.98