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 | $900.00 | $1,999.00 | $6,511.68 | |
BCBS
| Facility | $5,194.35 | $5,194.35 | $5,194.35 | |
Cigna
| Facility | $4,944.70 | $4,944.70 | $5,414.61 | |
United
| Facility | $985.00 | $3,428.00 | $9,302.00 |