| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $588.66 | $740.08 | $839.51 |
Tissue Grafts, Other (Eg, Paratenon, Fat, Dermis)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $588.66 | $740.08 | $839.51 |