| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,466.84 | $13,182.57 | $13,182.57 |
New Technology - Level 25 ($3501-$4000)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,466.84 | $13,182.57 | $13,182.57 |