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 | $1,517.00 | $3,827.00 | $10,234.00 | |
BCBS
| Facility | $2,430.00 | $7,138.00 | $13,961.00 | |
Lucent Health
| Facility | $55.00 | $27,110.45 | $27,110.45 | |
United
| Facility | $2,799.00 | $5,728.00 | $10,111.00 |