| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,276.81 | $1,276.81 | $9,500.00 | |
Medica
| Facility | $1,276.81 | $1,780.26 | $3,830.43 |
Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,276.81 | $1,276.81 | $9,500.00 | |
Medica
| Facility | $1,276.81 | $1,780.26 | $3,830.43 |