| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Regence BlueShield
| Professional | QX | $127.50 | $146.25 | $175.00 |
Regence BlueShield
| Professional | QY | $127.50 | $146.25 | $175.00 |
Anes Perq Img Dstrj Px Nulyt Agt Spi/Sp Lmbr/Sac
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Regence BlueShield
| Professional | QX | $127.50 | $146.25 | $175.00 |
Regence BlueShield
| Professional | QY | $127.50 | $146.25 | $175.00 |