| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | QK | $651.20 | $651.20 | $651.20 |
Providence
| Facility | QX | $651.20 | $651.20 | $651.20 |
Providence
| Facility | QY | $651.20 | $651.20 | $651.20 |
Anes Hrt Pericardial Sac& Grt Vesls W/O Pmp Oxt
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | QK | $651.20 | $651.20 | $651.20 |
Providence
| Facility | QX | $651.20 | $651.20 | $651.20 |
Providence
| Facility | QY | $651.20 | $651.20 | $651.20 |