| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $560.00 | $1,100.00 | $1,768.00 | |
BCBS
| Facility | $507.14 | $613.92 | $825.94 | |
United
| Facility | $375.00 | $1,141.00 | $2,481.00 |
Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $560.00 | $1,100.00 | $1,768.00 | |
BCBS
| Facility | $507.14 | $613.92 | $825.94 | |
United
| Facility | $375.00 | $1,141.00 | $2,481.00 |