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Hawaii 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
$2,747.00 / $2,747.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.30 / $1,495.14 / $2,116.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.28 / $1,706.85 / $1,706.85
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,989.67 / $2,235.46 / $2,637.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.03 / $1,638.58 / $1,911.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $2,155.00 / $2,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,392.79 / $1,706.85 / $2,223.08
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $1,451.36 / $2,221.06