| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $5,248.07 | $5,248.07 | $6,025.60 |
New Technology - Level 28 ($5001-$5500)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $5,248.07 | $5,248.07 | $6,025.60 |