| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,659.59 | $1,659.59 | $1,659.59 | |
Kaiser Permanente
| Facility | $102.33 | $120.23 | $151.36 | |
Providence
| Facility | $1,659.59 | $1,659.59 | $1,659.59 |
New Technology - Level 13 ($1101 - $1200)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,659.59 | $1,659.59 | $1,659.59 | |
Kaiser Permanente
| Facility | $102.33 | $120.23 | $151.36 | |
Providence
| Facility | $1,659.59 | $1,659.59 | $1,659.59 |