| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,047.13 | $1,047.13 | $1,202.26 |
New Technology - Level 12 ($1001 - $1100)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,047.13 | $1,047.13 | $1,202.26 |