| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $537.03 | $1,071.52 | $2,041.74 | |
BCBS
| Facility | $630.96 | $630.96 | $870.96 | |
United
| Facility | $331.13 | $912.01 | $2,089.30 |
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 | $537.03 | $1,071.52 | $2,041.74 | |
BCBS
| Facility | $630.96 | $630.96 | $870.96 | |
United
| Facility | $331.13 | $912.01 | $2,089.30 |