| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,570.88 | $5,754.40 | $8,128.31 |
New Technology - Level 28 ($5001-$5500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,570.88 | $5,754.40 | $8,128.31 |
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