| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $954.99 | $1,659.59 | $14,791.08 | |
BCBS
| Facility | $9,549.93 | $11,220.18 | $15,488.17 | |
United
| Facility | $1,479.11 | $4,365.16 | $7,244.36 |
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 | $954.99 | $1,659.59 | $14,791.08 | |
BCBS
| Facility | $9,549.93 | $11,220.18 | $15,488.17 | |
United
| Facility | $1,479.11 | $4,365.16 | $7,244.36 |