| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $4,745.25 | $4,745.25 | $4,745.25 | |
Midlands
| Facility | $1,214.01 | $1,214.01 | $1,214.01 | |
Midlands
| Professional | $1,214.01 | $1,214.01 | $1,214.01 |
Supchrdl Njx Of Rx Agt W/O Supply Of Medication
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $4,745.25 | $4,745.25 | $4,745.25 | |
Midlands
| Facility | $1,214.01 | $1,214.01 | $1,214.01 | |
Midlands
| Professional | $1,214.01 | $1,214.01 | $1,214.01 |