| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $854.76 | $6,515.00 | $10,882.00 | |
Horizon BCBS
| Facility | $18,741.68 | $20,603.88 | $39,900.96 | |
United
| Facility | $5,682.00 | $9,969.00 | $19,696.00 |
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 | $854.76 | $6,515.00 | $10,882.00 | |
Horizon BCBS
| Facility | $18,741.68 | $20,603.88 | $39,900.96 | |
United
| Facility | $5,682.00 | $9,969.00 | $19,696.00 |