| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $5.00 | $5.00 | $5.00 |
Medical/Surgical Supplies and Devices-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $5.00 | $5.00 | $5.00 |