| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,280.34 | $8,303.27 | $14,662.92 | |
Anthem BCBS
| Facility | $8,416.00 | $12,905.00 | $17,206.00 | |
United
| Facility | $6,787.00 | $10,417.00 | $16,323.00 |
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 | $4,280.34 | $8,303.27 | $14,662.92 | |
Anthem BCBS
| Facility | $8,416.00 | $12,905.00 | $17,206.00 | |
United
| Facility | $6,787.00 | $10,417.00 | $16,323.00 |