| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,522.00 | $7,629.00 | $10,565.00 | |
Anthem BCBS
| Facility | $8,416.00 | $12,905.00 | $17,206.00 | |
United
| Facility | $6,787.00 | $10,417.00 | $16,323.00 |
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 | $3,522.00 | $7,629.00 | $10,565.00 | |
Anthem BCBS
| Facility | $8,416.00 | $12,905.00 | $17,206.00 | |
United
| Facility | $6,787.00 | $10,417.00 | $16,323.00 |