| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,924.00 | $5,484.00 | $6,718.00 | |
Kaiser Permanente
| Professional | $758.30 | $827.23 | $965.10 | |
United
| Facility | $2,912.00 | $2,912.00 | $2,912.00 |
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 | $1,924.00 | $5,484.00 | $6,718.00 | |
Kaiser Permanente
| Professional | $758.30 | $827.23 | $965.10 | |
United
| Facility | $2,912.00 | $2,912.00 | $2,912.00 |