| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $870.96 | $870.96 | $870.96 |
New Technology - Level 5 ($301 - $400)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $870.96 | $870.96 | $870.96 |