| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,650.88 | $10,175.36 | $13,413.92 | |
Moda Health
| Facility | $256.44 | $1,348.59 | $5,869.32 | |
Providence
| Facility | $256.44 | $1,348.59 | $5,869.32 |
Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,650.88 | $10,175.36 | $13,413.92 | |
Moda Health
| Facility | $256.44 | $1,348.59 | $5,869.32 | |
Providence
| Facility | $256.44 | $1,348.59 | $5,869.32 |