| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,265.58 | $17,943.62 | $23,006.12 | |
Highmark BCBS
| Facility | $7,658.84 | $7,658.84 | $8,618.91 |
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 | $2,265.58 | $17,943.62 | $23,006.12 | |
Highmark BCBS
| Facility | $7,658.84 | $7,658.84 | $8,618.91 |