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New Hampshire rates for HCPCS 50430

Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,398.83 / $9,772.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,412.54 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $7,943.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $7,943.28
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19