| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $1,110.98 | $1,110.98 | $1,463.33 | |
Lucent Health
| Professional | $4,745.25 | $4,745.25 | $4,745.25 | |
Moda Health
| Professional | $450.00 | $450.00 | $450.00 |
Supchrdl Njx Of Rx Agt W/O Supply Of Medication
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $1,110.98 | $1,110.98 | $1,463.33 | |
Lucent Health
| Professional | $4,745.25 | $4,745.25 | $4,745.25 | |
Moda Health
| Professional | $450.00 | $450.00 | $450.00 |