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New Mexico rates for HCPCS 50690

Injection procedure for visualization of ileal conduit and/or ureteropyelography, exclusive of radiologic service

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.03 / $2,145.78 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.65 / $97.90 / $147.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.62 / $103.27 / $192.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.30 / $117.23 / $178.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $165.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.53 / $125.11 / $635.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.89 / $135.61 / $257.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.00 / $1,158.00 / $1,401.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.17 / $160.16 / $252.90