| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $47,000.00 | $81,499.99 | $94,999.99 | |
Cigna
| Facility | $1,093.14 | $1,093.14 | $1,093.14 | |
Providence
| Facility | $540.75 | $1,626.95 | $1,666.01 |
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 |
|---|---|---|---|---|---|
BCBS
| Facility | $47,000.00 | $81,499.99 | $94,999.99 | |
Cigna
| Facility | $1,093.14 | $1,093.14 | $1,093.14 | |
Providence
| Facility | $540.75 | $1,626.95 | $1,666.01 |