| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $758.58 | $758.58 | $1,023.29 |
Kaiser Permanente
| Professional | QX | $758.58 | $758.58 | $1,023.29 |
Kaiser Permanente
| Professional | QY | $758.58 | $758.58 | $1,023.29 |