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New Mexico rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$999.59 / $7,838.38 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$920.44 / $1,016.28 / $1,557.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.56 / $1,444.08 / $1,778.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $273.33 / $1,476.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.36 / $1,217.19 / $1,462.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.13 / $1,444.08 / $1,778.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,085.00 / $4,262.00 / $17,636.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,208.50 / $1,522.70 / $2,164.60