| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $862.51 | $862.51 | $862.51 | |
Medical Mutual of Ohio
| Facility | $862.51 | $862.51 | $862.51 |
New Technology - Level 5 ($301 - $400)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $862.51 | $862.51 | $862.51 | |
Medical Mutual of Ohio
| Facility | $862.51 | $862.51 | $862.51 |