go back

Utah 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
$1,995.26 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,479.11 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,905.46 / $3,019.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,388.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,630.27 / $7,079.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $2,570.40 / $3,630.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $3,090.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,621.81 / $2,884.03