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Maryland rates for HCPCS 51065

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $660.69 / $1,819.70
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $630.96 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $758.58 / $1,659.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $645.65 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $676.08 / $1,174.90
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $724.44 / $851.14