| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $261.39 | $315.00 | $315.00 | |
Aetna
| Professional | AA | $55.55 | $355.52 | $422.18 |
Aetna
| Professional | QZ | $316.64 | $383.30 | $484.68 |
Moda Health
| Professional | QY | $113.40 | $113.40 | $113.40 |