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Pennsylvania rates for HCPCS 52356

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $8,709.64 / $16,595.87
Aetna
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$9,120.11 / $18,620.87 / $23,988.33
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,011.87 / $8,912.51 / $26,915.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $575.44 / $1,737.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $602.56
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $630.96 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $537.03 / $812.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $562.34 / $616.60
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $512.86 / $758.58
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $10,715.19 / $19,498.45
Highmark BCBS
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$13,182.57 / $13,182.57 / $13,182.57
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,388.44 / $11,481.54 / $30,902.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $8,511.38 / $16,218.10
Martin's Point
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$9,120.11 / $9,120.11 / $23,988.33
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,011.87 / $8,912.51 / $25,118.86
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $602.56 / $1,659.59
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $8,511.38 / $12,882.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $630.96 / $870.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $457.09 / $1,318.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $588.84 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $489.78 / $831.76