| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $549.54 | $549.54 | $549.54 |
Aetna
| Professional | QZ | $467.74 | $616.60 | $776.25 |
Moda Health
| Professional | AA | $549.54 | $549.54 | $549.54 |
Moda Health
| Professional | QZ | $467.74 | $616.60 | $776.25 |