| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $1,891.49 | $2,483.56 | $2,891.83 |
Lam&Sctj Dentate Lig W/Wo Dural Grf Crv 1/2 Seg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $1,891.49 | $2,483.56 | $2,891.83 |