| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $31.00 | $31.00 | $410.26 |
Medical/Surgical Supplies Extension of 027X-Supplies Incident to Radiology
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $31.00 | $31.00 | $410.26 |