| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,715.35 | $3,715.35 | $3,715.35 | |
Martin's Point
| Facility | $3,715.35 | $3,715.35 | $3,715.35 |
Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,715.35 | $3,715.35 | $3,715.35 | |
Martin's Point
| Facility | $3,715.35 | $3,715.35 | $3,715.35 |