| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,374.84 | $4,374.84 | $4,374.84 | |
Priority Health
| Facility | $4,374.84 | $4,374.84 | $4,374.84 |
New Technology - Level 21 ($1901-$2000)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,374.84 | $4,374.84 | $4,374.84 | |
Priority Health
| Facility | $4,374.84 | $4,374.84 | $4,374.84 |