| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $677.90 | $677.90 | $812.21 | |
Pacific Source
| Facility | $250.00 | $313.50 | $356.04 |
Intro Guide Pelvis&/Ureter W/Dilat Nfros Tract
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $677.90 | $677.90 | $812.21 | |
Pacific Source
| Facility | $250.00 | $313.50 | $356.04 |