| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Professional | QK | $269.15 | $269.15 | $363.08 |
Kaiser Permanente
| Professional | QX | $269.15 | $269.15 | $363.08 |
Kaiser Permanente
| Professional | QY | $269.15 | $269.15 | $363.08 |