| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $177.83 | $933.25 | $8,511.38 | |
Medica
| Facility | $194.98 | $588.84 | $1,584.89 | |
United
| Facility | $1,819.70 | $2,041.74 | $2,041.74 |
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 | $177.83 | $933.25 | $8,511.38 | |
Medica
| Facility | $194.98 | $588.84 | $1,584.89 | |
United
| Facility | $1,819.70 | $2,041.74 | $2,041.74 |