| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
HealthNet
| Facility | $62.73 | $62.73 | $62.73 | |
Kaiser Permanente
| Facility | $118.50 | $195.00 | $315.00 |
Patient Convenience Items-Other Convenience Items
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
HealthNet
| Facility | $62.73 | $62.73 | $62.73 | |
Kaiser Permanente
| Facility | $118.50 | $195.00 | $315.00 |