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Maine rates for HCPCS 50630

Ureterolithotomy; lower one-third of ureter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,096.48 / $1,995.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $13,182.57 / $17,782.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,348.96 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,202.26 / $1,949.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,230.27 / $1,778.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,230.27 / $2,754.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,258.93 / $1,778.28