| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | QK | $203.50 | $203.50 | $203.50 |
Providence
| Facility | QX | $203.50 | $203.50 | $203.50 |
Providence
| Facility | QY | $203.50 | $203.50 | $203.50 |
Anes Radical Resecj Incl Below Knee Amputation
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | QK | $203.50 | $203.50 | $203.50 |
Providence
| Facility | QX | $203.50 | $203.50 | $203.50 |
Providence
| Facility | QY | $203.50 | $203.50 | $203.50 |