| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $5.13 | $5.13 | $26.92 | |
Emblem Health
| Facility | $57,543.99 | $57,543.99 | $57,543.99 |
Pharmacy - Drugs Incident to Radiology
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $5.13 | $5.13 | $26.92 | |
Emblem Health
| Facility | $57,543.99 | $57,543.99 | $57,543.99 |