| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,177.04 | $4,717.31 | $6,008.01 |
New Technology - Level 25 ($3501-$4000)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,177.04 | $4,717.31 | $6,008.01 |
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