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North Carolina 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
$1,126.64 / $1,615.00 / $6,953.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.64 / $1,181.27 / $2,037.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,543.43 / $1,988.20 / $2,944.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.93 / $1,920.57 / $3,194.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,126.64 / $1,576.60 / $2,873.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,576.60 / $1,576.60 / $2,882.70
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,872.00 / $2,853.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,366.00 / $9,541.00 / $14,589.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.48 / $1,631.70 / $3,581.46
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,478.40 / $10,496.96
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,559.12 / $10,441.96 / $10,441.96