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Maine 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
$444.75 / $6,061.14 / $12,000.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.18 / $657.05 / $1,320.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.35 / $700.01 / $1,329.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.17 / $735.11 / $1,638.99
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.74 / $940.19 / $1,628.48
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $6,061.14 / $17,203.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.06 / $632.71 / $1,333.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.10 / $1,329.49 / $1,628.48