| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $457.09 | $6,606.93 | $16,595.87 | |
Moda Health
| Facility | $147.91 | $245.47 | $977.24 | |
Providence
| Facility | $245.47 | $707.95 | $1,000.00 |
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 | $457.09 | $6,606.93 | $16,595.87 | |
Moda Health
| Facility | $147.91 | $245.47 | $977.24 | |
Providence
| Facility | $245.47 | $707.95 | $1,000.00 |