| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,400.00 | $2,819.52 | $4,101.12 |
AllWays Health Partners
| Facility | QK | $39.50 | $39.50 | $39.50 |
AllWays Health Partners
| Facility | QX | $39.50 | $39.50 | $39.50 |
AllWays Health Partners
| Facility | QY | $39.50 | $39.50 | $39.50 |
Mass General Brigham
| Facility | QK | $39.50 | $39.50 | $39.50 |
Mass General Brigham
| Facility | QX | $39.50 | $39.50 | $39.50 |
Mass General Brigham
| Facility | QY | $39.50 | $39.50 | $39.50 |
United
| Professional | AA | $85.00 | $85.00 | $85.00 |