| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $211.57 | $211.57 | $211.57 | |
Wellpoint
| Facility | $168.85 | $168.85 | $168.85 |
Ccpd / Composite Or Other Ra
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $211.57 | $211.57 | $211.57 | |
Wellpoint
| Facility | $168.85 | $168.85 | $168.85 |