| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
UPMC Health Plan
| Facility | $173.00 | $173.00 | $244.15 |
Medical Social Services-General
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
UPMC Health Plan
| Facility | $173.00 | $173.00 | $244.15 |