| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $11,500.00 | $11,500.00 | $11,500.00 |
Treatment/Observation Room - Other Treatment/Observation Rm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $11,500.00 | $11,500.00 | $11,500.00 |