| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $316.23 | $316.23 | $331.13 |
Aetna
| Professional | QZ | $263.03 | $263.03 | $263.03 |
Moda Health
| Professional | AA | $316.23 | $316.23 | $331.13 |
Moda Health
| Professional | QZ | $263.03 | $263.03 | $263.03 |