| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $297.97 | $380.19 | $412.05 |
Dom/R-Home E/M New Pt Signif New Prob 75 Minutes
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $297.97 | $380.19 | $412.05 |