| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $16,160.00 | $25,982.00 | $43,416.00 |
Urinary Stones W Esw Lithotripsy W Cc/Mcc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $16,160.00 | $25,982.00 | $43,416.00 |