| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,758.00 | $4,456.00 | $5,299.00 | |
Kaiser Permanente
| Professional | $215.12 | $1,135.79 | $1,445.56 | |
United
| Facility | $2,155.00 | $2,155.00 | $2,155.00 |
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 | $1,758.00 | $4,456.00 | $5,299.00 | |
Kaiser Permanente
| Professional | $215.12 | $1,135.79 | $1,445.56 | |
United
| Facility | $2,155.00 | $2,155.00 | $2,155.00 |