| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Emblem Health
| Professional | $101.62 | $101.62 | $101.62 | |
UPMC Health Plan
| Facility | $67.34 | $67.34 | $74.15 | |
UPMC Health Plan
| Professional | $67.34 | $71.76 | $74.15 | |
United
| Professional | $60.67 | $77.52 | $122.16 |