| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $486.20 | $486.20 | $486.20 |
Aetna
| Facility | QX | $800.80 | $800.80 | $800.80 |
Anes Lithotrp Xtrcorp Shock Wave W/O Water Bath
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $486.20 | $486.20 | $486.20 |
Aetna
| Facility | QX | $800.80 | $800.80 | $800.80 |