| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $412.59 | $5,142.00 | $8,084.00 | |
Horizon BCBS
| Facility | $6,990.20 | $8,075.85 | $18,183.06 | |
United
| Facility | $4,415.00 | $7,250.00 | $10,536.00 |
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 | $412.59 | $5,142.00 | $8,084.00 | |
Horizon BCBS
| Facility | $6,990.20 | $8,075.85 | $18,183.06 | |
United
| Facility | $4,415.00 | $7,250.00 | $10,536.00 |