| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $200.00 | $200.00 | $322.00 | |
Providence
| Facility | $11.19 | $52.70 | $373.08 |
Lithotripsy - General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $200.00 | $200.00 | $322.00 | |
Providence
| Facility | $11.19 | $52.70 | $373.08 |