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Pennsylvania rates for HCPCS 52353

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.00 / $5,244.55 / $12,504.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$13,296.00 / $13,296.00 / $13,296.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,547.00 / $8,831.50 / $19,139.18
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,304.86 / $8,032.22 / $19,261.15
Highmark BCBS
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$11,338.76 / $11,338.76 / $11,338.76
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,261.63 / $3,030.72 / $9,336.40
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.13 / $5,526.00 / $12,414.30
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$13,296.00 / $13,296.00 / $13,296.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$377.58 / $377.58 / $537.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,914.00 / $7,000.00