| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $854.76 | $6,515.00 | $10,882.00 | |
Horizon BCBS
| Facility | $18,741.68 | $20,603.88 | $39,900.96 | |
United
| Facility | $5,682.00 | $9,969.00 | $19,696.00 |
Perq Nl/Pl Lithotrp Simple Up To 2 Cm 1 Location
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $854.76 | $6,515.00 | $10,882.00 | |
Horizon BCBS
| Facility | $18,741.68 | $20,603.88 | $39,900.96 | |
United
| Facility | $5,682.00 | $9,969.00 | $19,696.00 |