| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $715.81 | $891.35 | $1,114.19 |
New Technology - Level 12 ($1001 - $1100)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $715.81 | $891.35 | $1,114.19 |