| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | $6,875.00 | $22,813.20 | $26,488.66 |
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | $6,875.00 | $22,813.20 | $26,488.66 |