| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | $90.00 | $90.00 | $90.00 |
Domicil/Rest Home New Pt Visit Hi Sever 60 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Providence
| Facility | $90.00 | $90.00 | $90.00 |