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Montana 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
$1,425.30 / $1,753.80 / $7,335.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,178.39 / $2,178.39 / $2,178.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,588.85 / $2,178.39 / $2,334.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,077.05 / $2,605.85 / $2,665.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,316.00 / $1,974.20 / $2,847.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,044.58 / $2,378.29 / $3,792.51