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New Hampshire 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
$100.00 / $4,655.35 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.27 / $1,664.59 / $2,132.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,299.00 / $14,347.98 / $25,014.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,400.72 / $2,184.17 / $3,299.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,464.58 / $2,367.27 / $3,781.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.76 / $2,538.79 / $4,215.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,949.00 / $9,949.00 / $9,949.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,487.21 / $2,043.53 / $3,807.38
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.15 / $1,092.18 / $1,605.50