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Utah rates for HCPCS 52317

Litholapaxy Smpl/Sm <2.5 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.58 / $3,038.00 / $6,975.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.18 / $862.12 / $1,744.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.17 / $975.89 / $1,612.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.80 / $730.58 / $944.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,086.24 / $6,609.94 / $9,632.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.17 / $1,150.09 / $1,652.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $3,613.00 / $7,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.07 / $967.77 / $1,797.85