| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $148.26 | $182.12 | $206.24 |
Indiv Phys Supvj Home/Dom/R-Home Mo 30 Min/>
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $148.26 | $182.12 | $206.24 |