| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $254.36 | $254.36 | $8,500.00 | |
Medica
| Facility | $254.36 | $320.70 | $763.08 |
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; including new access into the renal collecting system
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $254.36 | $254.36 | $8,500.00 | |
Medica
| Facility | $254.36 | $320.70 | $763.08 |