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 | $951.25 | $6,743.00 | $15,089.54 | |
Cigna
| Facility | $4,764.24 | $11,061.00 | $26,709.00 | |
Florida Blue
| Facility | $5,979.00 | $12,759.00 | $23,031.00 | |
United
| Facility | $3,320.00 | $10,309.00 | $15,888.00 |