| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $524.81 | $562.34 | $616.60 |
Aetna
| Professional | QZ | $467.74 | $645.65 | $933.25 |
Moda Health
| Professional | AA | $524.81 | $562.34 | $616.60 |
Moda Health
| Professional | QX | $204.17 | $302.00 | $645.65 |
Moda Health
| Professional | QZ | $467.74 | $660.69 | $954.99 |