| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $831.76 | $2,137.96 | $2,137.96 | |
Providence
| Facility | $1,659,586.91 | $1,659,586.91 | $1,659,586.91 | |
Providence
| Professional | $60.26 | $79.43 | $79.43 |
Unspecified Restorative Procedure, By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $831.76 | $2,137.96 | $2,137.96 | |
Providence
| Facility | $1,659,586.91 | $1,659,586.91 | $1,659,586.91 | |
Providence
| Professional | $60.26 | $79.43 | $79.43 |