| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,787.95 | $10,900.00 | $17,695.00 | |
Moda Health
| Facility | $1,609.04 | $5,990.62 | $8,566.59 | |
Providence
| Facility | $1,609.04 | $5,990.62 | $8,566.59 |
Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,787.95 | $10,900.00 | $17,695.00 | |
Moda Health
| Facility | $1,609.04 | $5,990.62 | $8,566.59 | |
Providence
| Facility | $1,609.04 | $5,990.62 | $8,566.59 |