| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $172.04 | $172.04 | $230.30 |
Kaiser Permanente
| Professional | QX | $172.04 | $172.04 | $230.30 |
Kaiser Permanente
| Professional | QY | $172.04 | $172.04 | $230.30 |