| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $173.78 | $173.78 | $229.09 |
Kaiser Permanente
| Professional | QX | $173.78 | $173.78 | $229.09 |
Kaiser Permanente
| Professional | QY | $173.78 | $173.78 | $229.09 |