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Virginia 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
$1,583.58 / $4,771.00 / $9,539.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,316.12 / $1,583.58 / $1,769.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,671.00 / $14,927.78 / $20,791.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.25 / $1,628.20 / $2,233.07
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,601.41 / $1,795.56 / $3,126.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,401.06 / $1,871.51 / $3,472.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.89 / $1,582.67 / $1,951.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,492.10 / $1,945.70 / $2,694.71
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,759.00 / $1,948.00 / $3,236.26
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.59 / $1,845.39 / $3,346.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,403.59 / $1,845.39 / $3,346.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,303.00 / $9,373.00 / $17,192.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,196.02 / $1,872.01 / $3,069.56