| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,412.54 | $5,128.61 | $6,918.31 | |
Kaiser Permanente
| Professional | $645.65 | $691.83 | $1,737.80 | |
United
| Facility | $4,073.80 | $16,218.10 | $45,708.82 |
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 | $1,412.54 | $5,128.61 | $6,918.31 | |
Kaiser Permanente
| Professional | $645.65 | $691.83 | $1,737.80 | |
United
| Facility | $4,073.80 | $16,218.10 | $45,708.82 |