| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $143.69 | $570.11 | $1,400.00 | |
CareSource
| Facility | $161.43 | $178.56 | $258.97 | |
Cigna
| Facility | $258.85 | $258.85 | $258.85 |
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 | $143.69 | $570.11 | $1,400.00 | |
CareSource
| Facility | $161.43 | $178.56 | $258.97 | |
Cigna
| Facility | $258.85 | $258.85 | $258.85 |