| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $174.20 | $174.20 | $174.20 |
Health Alliance Plan
| Facility | QX | $174.20 | $174.20 | $174.20 |
Anesthesia for transurethral procedures (including urethrocystoscopy); with fragmentation, manipulation and/or removal of ureteral calculus
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $174.20 | $174.20 | $174.20 |
Health Alliance Plan
| Facility | QX | $174.20 | $174.20 | $174.20 |