| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $724.44 | $1,174.90 | $1,737.80 |
Aetna
| Professional | QZ | $1,445.44 | $1,445.44 | $1,698.24 |
AllWays Health Partners
| Facility | QK | $52.48 | $52.48 | $52.48 |
AllWays Health Partners
| Facility | QX | $52.48 | $52.48 | $52.48 |
AllWays Health Partners
| Facility | QY | $52.48 | $52.48 | $52.48 |
Mass General Brigham
| Facility | QK | $52.48 | $52.48 | $52.48 |
Mass General Brigham
| Facility | QX | $52.48 | $52.48 | $52.48 |
Mass General Brigham
| Facility | QY | $52.48 | $52.48 | $52.48 |