| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Oscar Health
| Facility | $52.60 | $52.60 | $52.60 | |
Oscar Health
| Professional | $52.60 | $82.20 | $117.60 | |
UPMC Health Plan
| Facility | $64.84 | $64.84 | $75.84 | |
UPMC Health Plan
| Professional | $48.60 | $75.84 | $75.84 |