| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $105.10 | $105.10 | $105.10 | |
Health Alliance Plan
| Professional | $105.10 | $106.66 | $138.25 |
Indiv Phys Supvj Home/Dom/R-Home Mo 30 Min/>
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $105.10 | $105.10 | $105.10 | |
Health Alliance Plan
| Professional | $105.10 | $106.66 | $138.25 |