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Maine 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
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,698.24 / $4,265.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,197.01 / $19,498.45 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,137.96 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,905.46 / $3,090.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,905.46 / $2,754.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,905.46 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,995.26 / $2,754.23