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Maine rates for HCPCS C9761

Cystourethroscopy With Ureteroscopy And/Or Pyelo-Scopy With Lithotripsy And Ureteral Catheterization For Steerable Vacuum Aspiration Of The Kidney Collecting System Ureter Bladder And Urethra Ifapplicable (Must Use A Steerable Ureteral Catheter) (Desc Rvsd 1/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,200.77 / $4,200.77 / $7,574.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,804.54 / $9,804.54 / $9,804.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,940.52 / $24,940.52 / $24,940.52
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,200.77 / $4,200.77 / $7,574.11