| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,505.61 | $1,505.61 | $1,505.61 |
New Technology - Level 14 ($1201- $1300)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,505.61 | $1,505.61 | $1,505.61 |