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California rates for HCPCS 52317

Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.00 / $5,390.00 / $18,782.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.18 / $910.82 / $1,944.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,143.00 / $5,944.00 / $13,012.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.05 / $976.87 / $2,258.40
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.70 / $100.00 / $6,395.80
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.73 / $769.65 / $1,575.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,091.14 / $2,471.35 / $5,822.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.46 / $903.77 / $2,327.44
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.17 / $619.66 / $1,388.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.11 / $869.73 / $1,531.57
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,593.36 / $1,665.68 / $12,000.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,201.92 / $7,358.63 / $7,579.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.59 / $712.80 / $1,678.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.86 / $914.25 / $2,315.73
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.97 / $1,129.97 / $2,924.78
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.29 / $722.93 / $1,186.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,610.00 / $7,402.00 / $16,148.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.93 / $1,148.63 / $3,049.71