| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $200.00 | $200.00 | $322.00 | |
Pacific Source
| Facility | $472.00 | $1,007.86 | $1,617.87 |
Capd / Composite Or Other Ra
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $200.00 | $200.00 | $322.00 | |
Pacific Source
| Facility | $472.00 | $1,007.86 | $1,617.87 |