| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $588.84 | $588.84 | $588.84 |
Aetna
| Professional | QZ | $436.52 | $537.03 | $602.56 |
Moda Health
| Professional | AA | $588.84 | $588.84 | $588.84 |
Moda Health
| Professional | QZ | $436.52 | $537.03 | $602.56 |