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Idaho 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
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.27 / $1,499.69 / $2,619.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.28 / $1,984.66 / $2,215.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,307.47 / $2,302.34 / $2,777.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,844.54 / $1,956.33 / $2,235.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,614.06 / $2,030.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.00 / $1,757.00 / $2,160.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.97 / $1,678.25 / $2,637.25