| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $102.92 | $102.92 | $102.92 |
Ifxj Loclz&Trakg Trgt/Pt Mtn Dur Radtx Ea Fxj
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $102.92 | $102.92 | $102.92 |