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Alaska rates for HCPCS 51065

Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,236.00 / $9,774.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,709.94 / $2,709.94 / $3,738.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,982.48 / $1,982.48 / $1,982.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.68 / $2,709.94 / $3,875.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.58 / $3,681.30 / $4,766.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,191.25 / $2,541.85 / $3,689.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.68 / $2,709.94 / $3,875.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.10 / $2,508.00 / $3,737.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,475.23 / $1,590.98 / $3,659.25