| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $190.55 | $1,071.52 | $8,511.38 | |
Medica
| Facility | $208.93 | $616.60 | $1,819.70 | |
United
| Facility | $1,819.70 | $2,041.74 | $2,041.74 |
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 | $190.55 | $1,071.52 | $8,511.38 | |
Medica
| Facility | $208.93 | $616.60 | $1,819.70 | |
United
| Facility | $1,819.70 | $2,041.74 | $2,041.74 |