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Hawaii 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
$1,635.55 / $2,747.00 / $5,484.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.36 / $624.90 / $624.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.89 / $725.69 / $725.69
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.50 / $935.34 / $1,103.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.61 / $696.66 / $812.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $1,981.00 / $1,981.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.16 / $725.69 / $930.27
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.03 / $3,900.00 / $8,000.00