| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $150.37 | $253.38 | $303.70 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle or inverted Y, tangential ports, the use of wedges, compensators, complex blocking, rotational beam, or special beam considerations) (Only 1 teletherapy isodose plan may be reported for a given course of therapy to a specific treatment area)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $150.37 | $253.38 | $303.70 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |