| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $197.90 | $267.85 | $456.42 | |
United
| Facility | $150.00 | $150.00 | $150.00 |
Simple Repair F/E/E/N/L/M 12.6cm-20.0 Cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $197.90 | $267.85 | $456.42 | |
United
| Facility | $150.00 | $150.00 | $150.00 |