| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,265.97 | $7,299.07 | $18,016.80 | |
Martin's Point
| Facility | $4,265.97 | $7,932.07 | $20,719.34 |
Perq Nl/Pl Lithotrp Complex >2 Cm Mlt Locations
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,265.97 | $7,299.07 | $18,016.80 | |
Martin's Point
| Facility | $4,265.97 | $7,932.07 | $20,719.34 |