| 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 |
Anes Diag Arthroscopic Shoulder Joint Proc Nos
| 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 |