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California rates for HCPCS 50400

Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,290.50 / $9,639.00 / $20,509.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.06 / $1,252.63 / $4,553.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,446.00 / $10,450.00 / $21,131.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,325.03 / $1,766.11 / $3,381.46
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.50 / $100.00 / $5,485.17
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.01 / $1,246.49 / $3,067.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.07 / $1,508.43 / $4,594.50
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.77 / $1,277.91 / $1,533.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.11 / $1,470.88 / $2,665.70
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,478.40 / $10,733.36
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,559.12 / $10,108.39 / $10,441.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,225.73 / $1,562.20 / $2,146.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.74 / $1,510.09 / $3,272.61
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,788.74 / $3,788.74 / $3,788.74
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.77 / $1,391.66 / $1,754.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,110.00 / $9,707.00 / $21,278.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.00 / $1,445.23 / $3,706.42