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Pennsylvania rates for HCPCS 52317

Litholapaxy Smpl/Sm <2.5 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.30 / $2,266.00 / $9,184.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.33 / $801.42 / $1,428.15
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.61 / $1,059.60 / $1,459.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.89 / $706.10 / $1,605.62
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.11 / $1,320.27 / $1,356.30
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,146.07 / $7,824.86 / $12,676.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $2,152.00 / $8,922.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.64 / $808.39 / $1,821.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $1,292.20 / $2,428.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.50 / $777.12 / $1,605.62
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.16 / $600.96 / $1,302.89
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.16 / $841.42 / $920.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.04 / $1,112.32 / $1,721.87