| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,311.31 | $20,417.38 | $26,302.68 | |
Highmark BCBS
| Facility | $8,128.31 | $10,232.93 | $26,302.68 | |
United
| Facility | $1,995.26 | $1,995.26 | $1,995.26 |
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 | $3,311.31 | $20,417.38 | $26,302.68 | |
Highmark BCBS
| Facility | $8,128.31 | $10,232.93 | $26,302.68 | |
United
| Facility | $1,995.26 | $1,995.26 | $1,995.26 |