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Maine rates for HCPCS C9761

Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter)

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