| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $207.33 | $1,064.46 | $8,500.00 | |
Medica
| Facility | $207.33 | $1,064.46 | $1,809.58 |
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 | $207.33 | $1,064.46 | $8,500.00 | |
Medica
| Facility | $207.33 | $1,064.46 | $1,809.58 |