| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $820.96 | $5,834.83 | $9,649.76 | |
Cigna
| Facility | $5,040.18 | $5,040.18 | $5,040.18 | |
Kaiser Permanente
| Professional | $717.82 | $954.70 | $1,754.63 |
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 | $820.96 | $5,834.83 | $9,649.76 | |
Cigna
| Facility | $5,040.18 | $5,040.18 | $5,040.18 | |
Kaiser Permanente
| Professional | $717.82 | $954.70 | $1,754.63 |