| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Geisinger
| Professional | $213.80 | $213.80 | $213.80 | |
UPMC Health Plan
| Facility | $173.78 | $213.80 | $467.74 | |
UPMC Health Plan
| Professional | $158.49 | $190.55 | $467.74 | |
United
| Facility | $5,370.32 | $5,370.32 | $5,370.32 | |
United
| Professional | $107.15 | $144.54 | $223.87 |