| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,265.97 | $7,299.07 | $18,016.80 | |
Martin's Point
| Facility | $4,265.97 | $7,932.07 | $20,719.34 |
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 | $4,265.97 | $7,299.07 | $18,016.80 | |
Martin's Point
| Facility | $4,265.97 | $7,932.07 | $20,719.34 |