| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,677.35 | $8,511.38 | $19,054.61 | |
Anthem BCBS
| Facility | $8,912.51 | $17,378.01 | $31,622.78 | |
United
| Facility | $6,760.83 | $10,471.29 | $16,218.10 |
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 | $4,677.35 | $8,511.38 | $19,054.61 | |
Anthem BCBS
| Facility | $8,912.51 | $17,378.01 | $31,622.78 | |
United
| Facility | $6,760.83 | $10,471.29 | $16,218.10 |