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 | $860.00 | $2,549.00 | $6,000.00 | |
BCBS
| Facility | $6,824.25 | $11,960.86 | $18,548.98 | |
Christus
| Facility | $9,177.62 | $9,177.62 | $9,177.62 | |
United
| Facility | $1,141.00 | $4,717.00 | $10,810.00 |