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Tennessee 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
$1,821.00 / $3,167.18 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.35 / $1,256.39 / $1,757.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.00 / $2,387.00 / $6,183.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.21 / $1,471.60 / $2,567.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.92 / $1,619.88 / $2,539.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $10,496.96 / $10,733.36
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,559.12 / $10,108.39 / $10,441.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,259.00 / $4,567.00 / $7,669.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.43 / $1,580.51 / $2,631.83