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 | $1,300.00 | $4,192.00 | $13,200.00 | |
BCBS
| Facility | $7,701.16 | $12,172.15 | $19,381.03 | |
Medica
| Facility | $932.58 | $1,481.00 | $8,986.49 | |
United
| Facility | $1,280.00 | $5,524.00 | $9,232.95 |