| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $123.03 | $123.03 | $165.96 |
Kaiser Permanente
| Professional | QX | $123.03 | $123.03 | $165.96 |
Kaiser Permanente
| Professional | QY | $123.03 | $123.03 | $165.96 |