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Arizona 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
$1,671.00 / $3,617.00 / $6,329.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,310.28 / $1,472.67 / $5,683.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,598.50 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.42 / $1,145.90 / $1,432.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.71 / $1,685.26 / $3,065.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,332.78 / $1,940.67 / $6,117.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.32 / $1,623.15 / $12,225.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,878.00 / $4,545.00 / $7,217.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.32 / $1,531.77 / $2,667.73