| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $294.93 | $294.93 | $394.80 |
Kaiser Permanente
| Professional | QX | $294.93 | $294.93 | $394.80 |
Kaiser Permanente
| Professional | QY | $294.93 | $294.93 | $394.80 |