| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,528.00 | $6,084.00 | $7,424.00 | |
Kaiser Permanente
| Professional | $1,211.10 | $1,321.21 | $1,541.41 | |
United
| Facility | $2,912.00 | $2,912.00 | $2,912.00 |
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 | $2,528.00 | $6,084.00 | $7,424.00 | |
Kaiser Permanente
| Professional | $1,211.10 | $1,321.21 | $1,541.41 | |
United
| Facility | $2,912.00 | $2,912.00 | $2,912.00 |