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West 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
$1,316.12 / $1,316.12 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,233.99 / $1,386.18 / $1,583.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.33 / $1,642.27 / $1,789.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.48 / $1,590.48 / $1,590.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.97 / $1,582.97 / $1,582.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,351.87 / $1,988.10 / $12,225.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.49 / $1,635.14 / $2,471.77