| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $407.38 | $1,380.38 | $1,949.84 |
AllWays Health Partners
| Facility | QK | $52.48 | $52.48 | $52.48 |
AllWays Health Partners
| Facility | QX | $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 |