Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,412.54 | $1,905.46 | $4,073.80 | |
BCBS
| Facility | $8,709.64 | $8,709.64 | $12,022.64 | |
Cigna
| Facility | $4,677.35 | $4,677.35 | $4,677.35 | |
United
| Facility | $1,548.82 | $3,981.07 | $13,489.63 |