| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $5.12 | $5.12 | $27.03 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |
Pharmacy - Drugs Incident to Radiology
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $5.12 | $5.12 | $27.03 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |