| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $489.78 | $489.78 | $489.78 |
Aetna
| Facility | QX | $794.33 | $794.33 | $794.33 |
Anesthesia for lithotripsy, extracorporeal shock wave; without water bath
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $489.78 | $489.78 | $489.78 |
Aetna
| Facility | QX | $794.33 | $794.33 | $794.33 |