| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $288.40 | $389.05 | $407.38 |
Plmt Xtn Prosth Evasc Rpr Arysm/Dsj Ea Vsl
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $288.40 | $389.05 | $407.38 |