| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $82.37 | $104.40 | $116.88 |
Dom/R-Home E/M Est Pt Self-Lmtd/Minor 15 Minutes
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $82.37 | $104.40 | $116.88 |