| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Professional | QX | $102.33 | $120.23 | $141.25 |
BCBS
| Professional | QY | $102.33 | $120.23 | $141.25 |
Regence BlueShield
| Professional | QX | $102.33 | $114.82 | $141.25 |
Regence BlueShield
| Professional | QY | $102.33 | $114.82 | $141.25 |