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Washington 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

Facilitymedian $2,692 · 10th–90th $1,514$18,6210%10%10th90th$2,692Professionalmedian $1,585 · 10th–90th $1,096$2,9510%10%10th90th$1,585$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $3,019.95 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,479.11 / $2,884.03
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,187.76 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,187.76 / $3,388.44
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $2,344.23 / $2,951.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $2,344.23 / $2,951.21
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $72.44
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,238.72 / $2,238.72
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,584.89
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,454.71 / $3,388.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,187.76 / $2,884.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $7,079.46 / $11,481.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,819.70 / $3,162.28
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,380.38 / $2,089.30