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 | $2,398.83 | $3,890.45 | $18,620.87 | |
Anthem BCBS
| Facility | $9,332.54 | $10,471.29 | $19,952.62 | |
Harvard Pilgrim
| Facility | $11,220.18 | $11,220.18 | $11,220.18 | |
United
| Facility | $11,220.18 | $11,220.18 | $11,220.18 |