| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.00 | $3,525.24 | $9,859.00 | |
Anthem BCBS
| Facility | $8,992.79 | $9,992.00 | $19,050.00 | |
United
| Facility | $11,155.00 | $11,155.00 | $11,155.00 |
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 | $100.00 | $3,525.24 | $9,859.00 | |
Anthem BCBS
| Facility | $8,992.79 | $9,992.00 | $19,050.00 | |
United
| Facility | $11,155.00 | $11,155.00 | $11,155.00 |