| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
University Health Alliance
| Professional | $57.80 | $333.83 | $568.82 | |
University Health Alliance
| Professional | 26 | $37.03 | $60.31 | $133.04 |
University Health Alliance
| Professional | TC | $126.72 | $304.98 | $615.89 |