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 | $2,789.00 | $5,939.00 | $12,237.00 | |
BCBS
| Facility | $1,410.00 | $4,349.35 | $9,612.17 | |
Medica
| Facility | $55.00 | $1,233.05 | $7,208.00 | |
United
| Facility | $1,967.00 | $4,960.00 | $11,732.00 |