| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Wellcare
| Facility | QK | $181.97 | $181.97 | $181.97 |
Wellcare
| Facility | QX | $181.97 | $181.97 | $181.97 |
Wellcare
| Facility | QY | $181.97 | $181.97 | $181.97 |
Anesthesia for lithotripsy, extracorporeal shock wave; with water bath
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Wellcare
| Facility | QK | $181.97 | $181.97 | $181.97 |
Wellcare
| Facility | QX | $181.97 | $181.97 | $181.97 |
Wellcare
| Facility | QY | $181.97 | $181.97 | $181.97 |