| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,464.00 | $6,782.00 | $13,413.92 | |
Moda Health
| Facility | $190.09 | $701.20 | $1,002.72 | |
Providence
| Facility | $190.09 | $701.20 | $1,002.72 |
Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,464.00 | $6,782.00 | $13,413.92 | |
Moda Health
| Facility | $190.09 | $701.20 | $1,002.72 | |
Providence
| Facility | $190.09 | $701.20 | $1,002.72 |