| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $5,047.72 | $5,047.72 | $5,047.72 | |
Priority Health
| Facility | $5,047.72 | $5,047.72 | $5,047.72 |
New Technology - Level 22 ($2001-$2500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $5,047.72 | $5,047.72 | $5,047.72 | |
Priority Health
| Facility | $5,047.72 | $5,047.72 | $5,047.72 |