| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Emblem Health
| Facility | $6,087.00 | $6,087.00 | $6,087.00 |
Loa/Reserved
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Emblem Health
| Facility | $6,087.00 | $6,087.00 | $6,087.00 |