| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,423.94 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $240.82 | $1,267.69 | $5,366.89 | |
Providence
| Facility | $240.82 | $1,267.69 | $5,366.89 |
Convert nephrostomy catheter to 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, via pre-existing nephrostomy tract
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,423.94 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $240.82 | $1,267.69 | $5,366.89 | |
Providence
| Facility | $240.82 | $1,267.69 | $5,366.89 |