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Arkansas rates for HCPCS 50405

Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,819.70 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,584.89 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $2,238.72 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,818.38 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,445.44 / $2,630.27