| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $512.86 | $512.86 | $512.86 |
Aetna
| Professional | QZ | $1,445.44 | $1,698.24 | $2,137.96 |
Moda Health
| Professional | AA | $512.86 | $512.86 | $1,202.26 |
Moda Health
| Professional | QZ | $2,137.96 | $2,137.96 | $2,137.96 |