| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,044.03 | $1,044.03 | $1,200.64 |
New Technology - Level 12 ($1001 - $1100)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,044.03 | $1,044.03 | $1,200.64 |