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Indiana 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
$1,298.06 / $1,555.31 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.06 / $1,404.01 / $1,769.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,091.00 / $15,580.56 / $24,062.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,461.21 / $1,921.00 / $2,650.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,343.51 / $1,896.72 / $2,845.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.70 / $1,643.82 / $2,276.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.76 / $1,831.99 / $3,003.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,025.00 / $11,038.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,307.80 / $1,620.96 / $2,734.23