| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Emblem Health
| Professional | $217.71 | $217.71 | $217.71 | |
UPMC Health Plan
| Facility | $673.62 | $673.62 | $741.72 | |
UPMC Health Plan
| Professional | $673.62 | $710.32 | $741.72 | |
United
| Professional | $565.91 | $809.15 | $1,314.51 |