| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $194.25 | $194.25 | $194.25 | |
Pacific Source
| Facility | $219.84 | $286.50 | $363.89 |
Supchrdl Njx Of Rx Agt W/O Supply Of Medication
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | $194.25 | $194.25 | $194.25 | |
Pacific Source
| Facility | $219.84 | $286.50 | $363.89 |