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Illinois 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
$536.95 / $1,358.14 / $5,389.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.76 / $774.35 / $1,454.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,536.16 / $5,213.14 / $9,717.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.77 / $900.24 / $1,852.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$463.00 / $463.00 / $480.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.56 / $689.87 / $1,474.01
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.72 / $1,173.80 / $2,825.14
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.24 / $435.24 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,294.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$930.00 / $3,951.00 / $6,625.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.44 / $1,280.02 / $1,972.42