| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Geisinger
| Facility | $123.03 | $123.03 | $123.03 | |
UPMC Health Plan
| Facility | $117.49 | $117.49 | $117.49 | |
UPMC Health Plan
| Professional | $64.57 | $64.57 | $117.49 | |
United
| Professional | $91.20 | $91.20 | $125.89 |