| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $5,402.51 | $9,578.95 | |
Kaiser Permanente
| Professional | $714.05 | $1,560.99 | $1,560.99 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |
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 | $1,614.00 | $5,402.51 | $9,578.95 | |
Kaiser Permanente
| Professional | $714.05 | $1,560.99 | $1,560.99 | |
United
| Facility | $3,261.00 | $4,165.00 | $26,408.00 |