| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,799.85 | $4,799.85 | $4,799.85 | |
Medical Mutual of Ohio
| Facility | $4,799.85 | $4,799.85 | $4,799.85 |
New Technology - Level 21 ($1901-$2000)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,799.85 | $4,799.85 | $4,799.85 | |
Medical Mutual of Ohio
| Facility | $4,799.85 | $4,799.85 | $4,799.85 |