| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $977.24 | $10,000.00 | $16,982.44 | |
Moda Health
| Facility | $323.59 | $512.86 | $2,089.30 | |
Providence
| Facility | $524.81 | $1,513.56 | $2,137.96 |
Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $977.24 | $10,000.00 | $16,982.44 | |
Moda Health
| Facility | $323.59 | $512.86 | $2,089.30 | |
Providence
| Facility | $524.81 | $1,513.56 | $2,137.96 |