- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.49 / $295.25 / $341.83
| Professional | | $255.49 | $295.25 | $341.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.57 / $505.38 / $606.45
| Professional | | $396.57 | $505.38 | $606.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.95 / $526.16 / $633.17
| Professional | | $444.95 | $526.16 | $633.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.49 / $428.56 / $505.38
| Professional | | $313.49 | $428.56 | $505.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.63 / $502.35 / $655.89
| Professional | | $395.63 | $502.35 | $655.89 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.23 / $376.72 / $7,934.00
| Professional | | $69.23 | $376.72 | $7,934.00 |