| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $415.80 | $415.80 | $415.80 |
Anes Trurl Fragmntj Manj&/Rmvl Ureteral Calculus
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $415.80 | $415.80 | $415.80 |