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 | $899.95 | $8,148.88 | $8,148.88 | |
CareSource
| Facility | $739.99 | $820.26 | $893.69 | |
Cigna
| Facility | $791.47 | $791.47 | $791.47 | |
Highmark BCBS
| Facility | $9,771.81 | $18,562.29 | $20,762.84 |