| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $10,920.00 | $19,354.00 | $30,435.00 |
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $10,920.00 | $19,354.00 | $30,435.00 |