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 | $4,786.30 | $5,754.40 | $19,952.62 | |
BCBS
| Facility | $281.84 | $331.13 | $2,511.89 | |
Health Alliance Plan
| Facility | $3,235.94 | $5,754.40 | $12,589.25 | |
United
| Facility | $4,265.80 | $7,943.28 | $19,054.61 |