| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $868.76 | $868.76 | $868.76 |
Radiology Therapeutic and/or Chemotherapy Administration-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $868.76 | $868.76 | $868.76 |