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Texas 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
$969.00 / $3,682.00 / $12,040.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.25 / $1,215.83 / $1,757.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,161.08 / $1,983.53 / $9,276.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.11 / $1,229.69 / $2,297.77
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,016.37 / $1,016.37 / $1,016.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,177.30 / $1,554.28 / $2,401.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $10,496.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,559.12 / $10,108.39 / $10,441.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,137.56 / $1,509.67 / $2,564.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.69 / $1,710.39 / $2,012.22
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,658.60 / $1,658.60 / $1,658.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,137.56 / $1,530.09 / $2,735.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,177.30 / $1,584.04 / $2,486.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,345.00 / $10,600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.38 / $1,330.42 / $2,057.31
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.09 / $1,093.33 / $1,508.91