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New Mexico rates for HCPCS 50075

Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $7,838.38 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.62 / $1,565.76 / $2,384.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.59 / $2,232.34 / $2,741.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $418.83 / $2,259.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,482.89 / $1,887.31 / $2,254.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.46 / $2,232.34 / $2,741.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,085.00 / $4,616.00 / $17,636.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,860.50 / $2,315.48 / $3,320.38