| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $9,533.58 | $9,533.58 | $9,533.58 | |
Priority Health
| Facility | $9,533.58 | $9,533.58 | $9,533.58 |
New Technology - Level 26 ($4001-$4500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $9,533.58 | $9,533.58 | $9,533.58 | |
Priority Health
| Facility | $9,533.58 | $9,533.58 | $9,533.58 |