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Ohio 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
$1,386.18 / $8,553.00 / $14,415.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.18 / $1,386.18 / $2,756.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,142.00 / $12,455.21 / $21,287.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,170.01 / $1,628.06 / $2,670.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.27 / $1,578.32 / $2,466.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,446.80 / $1,520.79 / $2,564.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.30 / $1,858.85 / $2,836.46
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.76 / $1,992.55 / $2,740.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.97 / $1,393.08 / $1,985.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,840.00 / $5,998.00 / $7,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,341.08 / $1,759.58 / $3,107.40