| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $398.11 | $398.11 | $398.11 |
Plmt Xtn Prosth Evasc Rpr Infrarenal Rs&I
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $398.11 | $398.11 | $398.11 |