| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 | |
Highmark BCBS
| Facility | $3.68 | $5.32 | $128.00 |
Pharmacy-Nongeneric Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 | |
Highmark BCBS
| Facility | $3.68 | $5.32 | $128.00 |