| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $33.84 | $176.11 | $3,398.19 |
Medical/Surgical Supplies and Devices-Other Supplies/Devices
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $33.84 | $176.11 | $3,398.19 |