| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | $6,875.00 | $28,924.20 | $36,735.19 |
Urinary Stones W Esw Lithotripsy W Cc/Mcc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | $6,875.00 | $28,924.20 | $36,735.19 |