3617286 — 2102-2205 Vitoss Foam Pack 5cc
$4,741
All-payer median here
$3,161
Cash / self-pay here
10
payer/plan-name variants
Median over current-blob negotiated rates (COALESCE of standard / median / min–max midpoint, $0.01–$5M sentinel guard). Payers are canonical-grouped where a mapping exists; unmapped regional-plan name variants may appear as separate rows.