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Maine 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
Professional
Modifier
Low / Median / High Price
$1,181.27 / $1,488.99 / $1,757.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,783.47 / $23,063.27 / $26,006.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.12 / $1,540.79 / $2,353.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,381.61 / $1,723.91 / $2,469.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.76 / $1,648.22 / $2,528.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.27 / $1,488.99 / $2,132.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.74 / $1,643.15 / $2,280.39