| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,391.52 | $4,542.95 | $4,542.95 |
New Technology - Level 22 ($2001-$2500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,391.52 | $4,542.95 | $4,542.95 |