| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $129.28 | $129.28 | $129.28 | |
Medica
| Facility | $58.53 | $279.93 | $332.05 |
Unlistd Px Med Radj Physic Dosim&Tx Dev&Spec Svc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $129.28 | $129.28 | $129.28 | |
Medica
| Facility | $58.53 | $279.93 | $332.05 |