- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.19 / $180.03 / $256.75
| Professional | | $166.19 | $180.03 | $256.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.95 / $358.84 / $430.61
| Professional | | $282.95 | $358.84 | $430.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.04 / $326.26 / $450.30
| Professional | | $280.04 | $326.26 | $450.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.85 / $304.29 / $358.84
| Professional | | $198.85 | $304.29 | $358.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.56 / $358.84 / $462.99
| Professional | | $281.56 | $358.84 | $462.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.83 / $1,350.00 / $3,663.00
| Professional | | $212.83 | $1,350.00 | $3,663.00 |