| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,774.00 | $14,552.94 | |
Moda Health
| Facility | $876.16 | $3,263.82 | $4,667.26 | |
Providence
| Facility | $876.16 | $3,263.82 | $4,667.26 |
Perq Nl/Pl Lithotrp Simple Up To 2 Cm 1 Location
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,774.00 | $14,552.94 | |
Moda Health
| Facility | $876.16 | $3,263.82 | $4,667.26 | |
Providence
| Facility | $876.16 | $3,263.82 | $4,667.26 |