| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $393.99 | $477.00 | $8,500.00 | |
Medica
| Facility | $393.99 | $545.39 | $1,181.97 |
Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $393.99 | $477.00 | $8,500.00 | |
Medica
| Facility | $393.99 | $545.39 | $1,181.97 |