| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $0.92 | $3.15 | $54.40 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |
Pharmacy - Other Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $0.92 | $3.15 | $54.40 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |