| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $503.67 | $596.86 | $991.87 | |
United
| Facility | $450.00 | $450.00 | $450.00 |
Repair Intermediate S/A/T/E >30.0 Cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $503.67 | $596.86 | $991.87 | |
United
| Facility | $450.00 | $450.00 | $450.00 |