| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $329.88 | $2,744.63 | $2,744.63 | |
Martin's Point
| Facility | $2,744.63 | $2,744.63 | $4,950.60 |
Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $329.88 | $2,744.63 | $2,744.63 | |
Martin's Point
| Facility | $2,744.63 | $2,744.63 | $4,950.60 |