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Texas 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
$884.99 / $3,620.00 / $12,040.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.26 / $613.52 / $857.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,837.43 / $4,980.59 / $9,266.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.49 / $668.94 / $931.99
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.22 / $520.22 / $520.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,376.10 / $2,376.10 / $2,376.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.54 / $779.78 / $1,211.08
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,388.90 / $26,542.00 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,677.00 / $9,677.00 / $9,677.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.76 / $738.28 / $1,280.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.14 / $867.56 / $1,020.65
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.60 / $831.60 / $831.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.76 / $745.10 / $1,473.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.03 / $788.62 / $1,313.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,154.00 / $3,314.00 / $7,600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.74 / $663.76 / $1,025.81
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.94 / $553.12 / $765.72