| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $19.50 | $19.50 | $19.50 | |
Emblem Health
| Facility | $57,543.99 | $57,543.99 | $57,543.99 |
Pharmacy-Nongeneric Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $19.50 | $19.50 | $19.50 | |
Emblem Health
| Facility | $57,543.99 | $57,543.99 | $57,543.99 |