| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,109.61 | $1,508.95 | $1,948.28 | |
Providence
| Facility | $1,109.61 | $1,508.95 | $2,657.92 |
New Technology - Level 13 ($1101 - $1200)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,109.61 | $1,508.95 | $1,948.28 | |
Providence
| Facility | $1,109.61 | $1,508.95 | $2,657.92 |