| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Emblem Health
| Professional | $217.71 | $217.71 | $217.71 | |
UPMC Health Plan
| Facility | $173.86 | $173.86 | $191.43 | |
UPMC Health Plan
| Professional | $173.86 | $181.61 | $191.43 | |
United
| Professional | $100.22 | $144.66 | $248.54 |