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Louisiana 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
$933.25 / $2,691.53 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,659.59 / $3,019.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $14,454.40 / $19,952.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,905.46 / $2,290.87
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,819.70 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,467.37 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,584.89 / $2,570.40