| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $196.62 | $196.62 | $263.20 |
Kaiser Permanente
| Professional | QX | $196.62 | $196.62 | $263.20 |
Kaiser Permanente
| Professional | QY | $196.62 | $196.62 | $263.20 |