go back

Michigan 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
$1,769.29 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,400.90 / $1,697.61 / $1,769.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,574.43 / $7,674.34 / $10,454.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.21 / $1,972.28 / $3,269.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.17 / $1,608.87 / $2,847.04
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,415.56 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,415.56 / $1,570.17 / $2,285.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.87 / $1,233.76 / $1,849.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,296.00 / $7,849.00 / $9,202.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,534.23 / $1,858.53 / $2,419.73