| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,122.42 | $1,122.42 | $1,403.02 |
New Technology - Level 16 ($1401 - $1500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,122.42 | $1,122.42 | $1,403.02 |