| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,288.25 | $9,549.93 | $11,481.54 | |
Medica
| Facility | $1,288.25 | $2,187.76 | $10,471.29 | |
United
| Facility | $7,943.28 | $8,912.51 | $8,912.51 |
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 | $1,288.25 | $9,549.93 | $11,481.54 | |
Medica
| Facility | $1,288.25 | $2,187.76 | $10,471.29 | |
United
| Facility | $7,943.28 | $8,912.51 | $8,912.51 |