| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $800.00 | $1,642.78 | $5,380.05 | |
BCBS
| Facility | $9,255.62 | $11,204.67 | $15,073.87 | |
United
| Facility | $1,485.00 | $4,121.00 | $7,227.00 |
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 | $800.00 | $1,642.78 | $5,380.05 | |
BCBS
| Facility | $9,255.62 | $11,204.67 | $15,073.87 | |
United
| Facility | $1,485.00 | $4,121.00 | $7,227.00 |