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Vermont rates for HCPCS 50130

Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,318.26 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,412.54 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,479.11 / $4,265.80