| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $19.55 | $19.55 | $19.55 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |
Pharmacy - Non-Generic Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $19.55 | $19.55 | $19.55 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |