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Montana 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
$3,733.50 / $3,733.50 / $7,982.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.82 / $908.00 / $1,401.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.32 / $536.32 / $1,389.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.32 / $536.32 / $536.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.32 / $583.16 / $1,389.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.94 / $1,670.50 / $1,708.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.25 / $845.20 / $1,456.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,205.22 / $1,498.21 / $2,457.71