| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $2,709.62 | $2,709.62 | $2,709.62 |
New Technology - Level 22 ($2001-$2500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $2,709.62 | $2,709.62 | $2,709.62 |