| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $831.76 | $3,630.78 | $7,943.28 | |
Cigna
| Facility | $630.96 | $630.96 | $630.96 | |
Medica
| Facility | $173.78 | $707.95 | $1,479.11 | |
United
| Facility | $489.78 | $794.33 | $2,570.40 |
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 | $831.76 | $3,630.78 | $7,943.28 | |
Cigna
| Facility | $630.96 | $630.96 | $630.96 | |
Medica
| Facility | $173.78 | $707.95 | $1,479.11 | |
United
| Facility | $489.78 | $794.33 | $2,570.40 |