| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,143.42 | $1,143.42 | $1,314.93 |
New Technology - Level 13 ($1101 - $1200)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,143.42 | $1,143.42 | $1,314.93 |