| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $407.38 | $407.38 | $407.38 |
Aetna
| Professional | QZ | $467.74 | $467.74 | $467.74 |
Moda Health
| Professional | AA | $407.38 | $407.38 | $407.38 |
Moda Health
| Professional | QZ | $467.74 | $467.74 | $467.74 |