| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $812.89 | $812.89 | $1,016.11 |
New Technology - Level 12 ($1001 - $1100)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $812.89 | $812.89 | $1,016.11 |