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 | $884.21 | $3,708.00 | $6,254.09 | |
BCBS
| Facility | $8,726.40 | $10,186.34 | $13,876.60 | |
Health Alliance Plan
| Facility | $882.54 | $3,708.00 | $4,933.00 | |
United
| Facility | $4,069.00 | $8,847.00 | $10,652.00 |