| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $10,459.77 | $10,459.77 | $10,459.77 | |
Medical Mutual of Ohio
| Facility | $10,459.77 | $10,459.77 | $10,459.77 |
New Technology - Level 26 ($4001-$4500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $10,459.77 | $10,459.77 | $10,459.77 | |
Medical Mutual of Ohio
| Facility | $10,459.77 | $10,459.77 | $10,459.77 |