| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $258.89 | $1,173.03 | $8,500.00 | |
Medica
| Facility | $258.89 | $1,173.03 | $2,698.78 |
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 | $258.89 | $1,173.03 | $8,500.00 | |
Medica
| Facility | $258.89 | $1,173.03 | $2,698.78 |