| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $105.62 | $139.52 | $146.93 |
Indiv Phys Supvj Home/Dom/R-Home Mo 15-29 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $105.62 | $139.52 | $146.93 |