| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,103.78 | $1,244.04 | $1,487.94 |
New Technology - Level 15 ($1301 - $1400)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,103.78 | $1,244.04 | $1,487.94 |
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