| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,236.30 | $5,743.00 | $7,679.00 | |
Regence BlueShield
| Facility | $13,653.00 | $17,467.05 | $25,454.49 | |
United
| Facility | $2,912.00 | $7,693.00 | $13,847.00 |
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 | $1,236.30 | $5,743.00 | $7,679.00 | |
Regence BlueShield
| Facility | $13,653.00 | $17,467.05 | $25,454.49 | |
United
| Facility | $2,912.00 | $7,693.00 | $13,847.00 |