| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,281.33 | $1,281.33 | $8,500.00 | |
Medica
| Facility | $1,281.33 | $1,787.31 | $10,482.17 |
Perq Nl/Pl Lithotrp Complex >2 Cm Mlt Locations
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,281.33 | $1,281.33 | $8,500.00 | |
Medica
| Facility | $1,281.33 | $1,787.31 | $10,482.17 |