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Tennessee 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
$1,794.50 / $3,175.95 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.74 / $1,715.15 / $2,200.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.00 / $2,387.00 / $6,243.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.88 / $1,749.46 / $3,105.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,347.22 / $1,951.78 / $3,064.17
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $12,661.36 / $12,945.04
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,530.13 / $12,225.55 / $12,628.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,259.00 / $4,567.00 / $7,669.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,359.61 / $1,971.43 / $3,175.34