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 | $3,000.00 | $6,560.00 | $12,154.00 | |
BCBS
| Facility | $1,410.00 | $4,379.75 | $6,949.81 | |
Medica
| Facility | $55.00 | $1,842.65 | $7,310.00 | |
United
| Facility | $1,967.00 | $4,960.00 | $11,769.00 |