| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $110.00 | $110.00 | $280.00 | |
University Health Alliance
| Facility | $110.00 | $110.00 | $110.00 |
Patient Convenience Items-Other Convenience Items
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $110.00 | $110.00 | $280.00 | |
University Health Alliance
| Facility | $110.00 | $110.00 | $110.00 |