| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $933.25 | $933.25 | $933.25 |
Aetna
| Professional | QZ | $954.99 | $954.99 | $2,187.76 |
Moda Health
| Professional | AA | $933.25 | $933.25 | $1,071.52 |
Moda Health
| Professional | QZ | $954.99 | $954.99 | $954.99 |