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Anesthesia For Shock Wave Kidney Stone Treatment

Pennsylvania rates for HCPCS 00873

Covers the anesthesia for lithotripsy, a treatment that sends focused shock waves through the skin to break a kidney stone into fragments small enough to pass in the urine. The anesthesia keeps you still and comfortable while the shocks are delivered. The doctor performing the treatment charges separately.

Rates data updated July 2026.

Facilitymedian $6 · 10th–90th $5$60%50%10th$6$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
QK · Directing 2–4 cases
Typical Low
$5.01
Median
$5.01
Typical High
$5.89
Aetna
Setting
Facility
Modifier
QY · Directing one CRNA
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Cigna
Setting
Facility
Modifier
QK · Directing 2–4 cases
Typical Low
$30.90
Median
$30.90
Typical High
$30.90
Cigna
Setting
Facility
Modifier
QX · CRNA, directed
Typical Low
$30.90
Median
$30.90
Typical High
$30.90
Cigna
Setting
Facility
Modifier
QY · Directing one CRNA
Typical Low
$30.90
Median
$30.90
Typical High
$30.90
Highmark BCBS
Setting
Facility
Modifier
QZ · CRNA, independent
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Martin's Point
Setting
Facility
Modifier
QK · Directing 2–4 cases
Typical Low
$5.01
Median
$5.01
Typical High
$5.89
Martin's Point
Setting
Facility
Modifier
QY · Directing one CRNA
Typical Low
$5.89
Median
$5.89
Typical High
$5.89