| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $272.58 | $408.92 | $483.08 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Brachytherapy isodose plan; complex (multiplane isodose plan, volume implant calculations, over 10 sources/ribbons used, special spatial reconstruction, remote afterloading brachytherapy, over 12 sources)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $272.58 | $408.92 | $483.08 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |