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 | $1,193.19 | $7,536.90 | $7,838.38 | |
BCBS
| Facility | $6,812.51 | $16,343.29 | $27,379.36 | |
Providence
| Facility | $931.86 | $1,186.01 | $1,342.81 | |
United
| Facility | $7,315.00 | $11,259.00 | $12,494.00 |