| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $3,727.41 | $3,727.41 | $4,286.52 |
New Technology - Level 25 ($3501-$4000)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $3,727.41 | $3,727.41 | $4,286.52 |