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North Carolina rates for HCPCS 00873

Anesthesia for lithotripsy, extracorporeal shock wave; without water bath

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$591.29 / $591.29 / $591.29
Wellcare
Facility/Professional
Facility
Modifier
QK
Low / Median / High Price
$37.00 / $37.00 / $39.50
Wellcare
Facility/Professional
Facility
Modifier
QX
Low / Median / High Price
$37.00 / $37.00 / $39.50
Wellcare
Facility/Professional
Facility
Modifier
QY
Low / Median / High Price
$37.00 / $37.00 / $39.50