Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,106.24 | $5,378.25 | $10,310.50 | |
BCBS
| Facility | $4,989.00 | $9,720.00 | $17,206.00 | |
Cigna
| Facility | $4,769.12 | $4,986.83 | $5,877.84 | |
United
| Facility | $3,206.00 | $6,578.00 | $12,241.00 |
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