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 | $836.90 | $4,908.00 | $10,387.00 | |
Anthem BCBS
| Facility | $2,088.00 | $4,247.00 | $9,663.00 | |
Medica
| Facility | $568.80 | $1,298.71 | $8,361.00 | |
United
| Facility | $2,156.00 | $4,039.00 | $10,781.00 |