| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $645.65 | $645.65 | $851.14 |
Kaiser Permanente
| Professional | QX | $645.65 | $645.65 | $851.14 |
Kaiser Permanente
| Professional | QY | $645.65 | $645.65 | $851.14 |