| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,062.90 | $4,062.90 | $5,078.62 |
New Technology - Level 28 ($5001-$5500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,062.90 | $4,062.90 | $5,078.62 |