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West Virginia 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
$327.05 / $810.48 / $14,991.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.05 / $703.23 / $1,027.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.36 / $407.76 / $444.26
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.90 / $394.90 / $394.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.46 / $587.46 / $587.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.89 / $975.50 / $2,144.88
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,561.95 / $17,561.95 / $17,561.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.02 / $1,035.64 / $2,096.89