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Pennsylvania rates for HCPCS 50630

Ureterolithotomy; lower one-third of ureter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $6,165.95 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $2,089.30
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,122.02 / $1,737.80
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,230.27 / $1,348.96
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,096.48 / $1,737.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $5,248.07 / $9,549.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $2,754.23
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,778.28
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $1,862.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,071.52 / $1,071.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $870.96 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,778.28