| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Geisinger
| Professional | $131.83 | $131.83 | $190.55 | |
UPMC Health Plan
| Facility | $104.71 | $186.21 | $416.87 | |
UPMC Health Plan
| Professional | $104.71 | $177.83 | $407.38 | |
United
| Professional | $79.43 | $104.71 | $104.71 |