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 | $756.00 | $2,418.00 | $4,509.00 | |
BCBS
| Facility | $6,824.25 | $11,960.86 | $18,548.98 | |
Christus
| Facility | $9,724.24 | $9,724.24 | $9,724.24 | |
United
| Facility | $1,141.00 | $4,717.00 | $10,810.00 |