| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Blue Shield
| Facility | $23.44 | $23.44 | $23.44 | |
HealthNet
| Facility | $1,445.44 | $4,168.69 | $16,595.87 | |
Kaiser Permanente
| Facility | $117.49 | $194.98 | $316.23 |
Pharmacy-Other Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Blue Shield
| Facility | $23.44 | $23.44 | $23.44 | |
HealthNet
| Facility | $1,445.44 | $4,168.69 | $16,595.87 | |
Kaiser Permanente
| Facility | $117.49 | $194.98 | $316.23 |