| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,570.40 | $6,025.60 | $6,025.60 | |
Kaiser Permanente
| Professional | $1,096.48 | $1,202.26 | $1,479.11 | |
United
| Facility | $2,884.03 | $2,884.03 | $2,884.03 |
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 | $2,570.40 | $6,025.60 | $6,025.60 | |
Kaiser Permanente
| Professional | $1,096.48 | $1,202.26 | $1,479.11 | |
United
| Facility | $2,884.03 | $2,884.03 | $2,884.03 |