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Maryland 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
$0.98 / $998.89 / $4,398.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.42 / $946.63 / $2,411.30
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.99 / $377.50 / $470.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.52 / $1,745.52 / $1,745.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.77 / $824.09 / $2,086.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.88 / $1,168.91 / $2,069.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.75 / $1,146.47 / $1,906.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.30 / $1,010.71 / $1,248.61