| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $456.72 | $456.72 | $456.72 | |
Martin's Point
| Facility | $456.72 | $456.72 | $456.72 |
Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $456.72 | $456.72 | $456.72 | |
Martin's Point
| Facility | $456.72 | $456.72 | $456.72 |