- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.59 / $58.21 / $72.79
| Professional | | $38.59 | $58.21 | $72.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.46 / $103.50 / $124.20
| Professional | | $84.46 | $103.50 | $124.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.26 / $81.90 / $114.86
| Professional | | $69.26 | $81.90 | $114.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.66 / $91.08 / $107.64
| Professional | | $51.66 | $91.08 | $107.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.29 / $103.50 / $189.24
| Professional | | $81.29 | $103.50 | $189.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $54.94 / $92.09
| Professional | | $29.27 | $54.94 | $92.09 |