| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,023.29 | $3,162.28 | $4,570.88 | |
U of Utah Health Plan
| Professional | $239.88 | $1,071.52 | $1,548.82 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |
Balloon dilation, ureteral stricture, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,023.29 | $3,162.28 | $4,570.88 | |
U of Utah Health Plan
| Professional | $239.88 | $1,071.52 | $1,548.82 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |