| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $1,100.00 | $1,100.00 | $1,100.00 |
Dialysis / Ultrafiltration
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $1,100.00 | $1,100.00 | $1,100.00 |