| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Professional | $141.00 | $141.00 | $180.42 |
Ffs - Not Available
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Professional | $141.00 | $141.00 | $180.42 |