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Montana 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
$1,133.06 / $1,239.83 / $2,338.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,806.12 / $1,806.12 / $1,806.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,322.11 / $1,806.12 / $1,931.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$892.86 / $2,155.40 / $2,209.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.17 / $1,636.92 / $2,361.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.17 / $2,016.60 / $3,141.30