| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,331.00 | $20,631.20 | $26,539.90 | |
Highmark BCBS
| Facility | $8,169.59 | $8,864.77 | $26,264.48 |
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 | $3,331.00 | $20,631.20 | $26,539.90 | |
Highmark BCBS
| Facility | $8,169.59 | $8,864.77 | $26,264.48 |