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Wisconsin 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
$1,047.13 / $2,089.30 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,047.13 / $2,570.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $19,054.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,949.84 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,090.30 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $3,235.94 / $3,715.35
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $6,760.83 / $13,489.63
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $3,162.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $2,818.38 / $7,943.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,819.70 / $7,585.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,380.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $2,344.23 / $3,981.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $9,332.54 / $9,332.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $5,011.87 / $7,585.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $6,025.60 / $7,585.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,165.95 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,698.24 / $4,365.16