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Maine 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
$624.89 / $743.25 / $834.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.90 / $770.99 / $1,193.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.64 / $871.07 / $1,247.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.14 / $836.04 / $1,282.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.90 / $743.25 / $834.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.89 / $886.91 / $1,158.83