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Washington 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
$4,425.00 / $13,314.00 / $27,982.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,804.54 / $9,804.54 / $9,804.54
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,316.13 / $26,106.65 / $50,506.09
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,406.43 / $5,406.43 / $5,406.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,795.54 / $6,795.54 / $11,321.29
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,428.82 / $16,092.85 / $38,719.32
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,777.41 / $22,295.00 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,563.22 / $5,563.22 / $5,563.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,231.92 / $25,527.34 / $49,939.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,406.43 / $5,406.43 / $5,406.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.00 / $4,818.00 / $10,522.00