| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $189.96 | $899.15 | $1,700.00 | |
CareSource
| Facility | $236.05 | $236.05 | $257.19 | |
Cigna
| Facility | $341.98 | $341.98 | $341.98 |
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 | $189.96 | $899.15 | $1,700.00 | |
CareSource
| Facility | $236.05 | $236.05 | $257.19 | |
Cigna
| Facility | $341.98 | $341.98 | $341.98 |