| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $75.58 | $96.00 | $105.14 |
Domicil/Rest Home New Pt Visit Low Sever 20 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $75.58 | $96.00 | $105.14 |