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New Mexico rates for HCPCS 50694

Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $1,584.89 / $8,709.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $933.25 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $9,120.11 / $15,488.17