| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $126.75 | $126.75 | $158.44 | |
Priority Health
| Professional | $126.75 | $126.75 | $158.44 | |
UPMC Health Plan
| Facility | $114.43 | $114.43 | $125.87 | |
UPMC Health Plan
| Professional | $100.70 | $114.43 | $125.87 |