| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $786.14 | $786.14 | $786.14 | |
Priority Health
| Facility | $786.14 | $786.14 | $786.14 |
New Technology - Level 5 ($301 - $400)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $786.14 | $786.14 | $786.14 | |
Priority Health
| Facility | $786.14 | $786.14 | $786.14 |