| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $0.28 | $11.77 | $116.33 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |
Drugs Requiring Specific Ident - Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $0.28 | $11.77 | $116.33 | |
Emblem Health
| Facility | $56,999.43 | $56,999.43 | $56,999.43 |