| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $457.09 | $457.09 | $457.09 |
Aetna
| Professional | QZ | $489.78 | $537.03 | $870.96 |
Moda Health
| Professional | AA | $457.09 | $457.09 | $457.09 |
Moda Health
| Professional | QZ | $489.78 | $537.03 | $870.96 |