| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $2,238.72 | $2,754.23 | $3,235.94 |
Lam&Sctj Dentate Lig W/Wo Dural Grf Crv >2 Seg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $2,238.72 | $2,754.23 | $3,235.94 |