| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $520.00 | $805.98 | $1,283.33 |
Aetna
| Professional | QZ | $201.50 | $201.50 | $201.50 |
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 |