| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Fidelis
| Facility | $210.00 | $210.00 | $210.00 |
Anesthesia-Anesthesia Incident to Other Diagnostic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Fidelis
| Facility | $210.00 | $210.00 | $210.00 |