| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.54 | $575.44 | $8,511.38 | |
Medica
| Facility | $186.21 | $467.74 | $1,096.48 | |
United
| Facility | $1,819.70 | $2,041.74 | $2,041.74 |
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 | $144.54 | $575.44 | $8,511.38 | |
Medica
| Facility | $186.21 | $467.74 | $1,096.48 | |
United
| Facility | $1,819.70 | $2,041.74 | $2,041.74 |