| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,464.00 | $6,782.00 | $13,413.92 | |
Moda Health
| Facility | $200.67 | $803.29 | $1,148.70 | |
Providence
| Facility | $200.67 | $803.29 | $1,148.70 |
Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,464.00 | $6,782.00 | $13,413.92 | |
Moda Health
| Facility | $200.67 | $803.29 | $1,148.70 | |
Providence
| Facility | $200.67 | $803.29 | $1,148.70 |