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Indiana 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
$383.66 / $4,846.00 / $14,368.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.67 / $740.98 / $1,027.43
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.43 / $207.43 / $207.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,682.00 / $3,950.00 / $13,810.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.32 / $836.81 / $2,707.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.16 / $405.50 / $1,084.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.56 / $875.04 / $1,143.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,218.40 / $2,218.40 / $2,218.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.74 / $710.85 / $1,811.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,364.00 / $6,094.00 / $10,413.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.46 / $1,171.51 / $1,745.81