| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $338.04 | $459.70 | $593.54 | |
Providence
| Facility | $338.04 | $459.70 | $809.72 |
New Technology - Level 5 ($301 - $400)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $338.04 | $459.70 | $593.54 | |
Providence
| Facility | $338.04 | $459.70 | $809.72 |