- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.52 / $67.95 / $108.29
| Professional | | $46.52 | $67.95 | $108.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.94 / $84.38 / $101.25
| Professional | | $63.94 | $84.38 | $101.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.05 / $81.66 / $100.35
| Professional | | $69.05 | $81.66 | $100.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.09 / $71.55 / $84.38
| Professional | | $48.09 | $71.55 | $84.38 |
- 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
- $65.15 / $84.38 / $100.41
| Professional | | $65.15 | $84.38 | $100.41 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $58.28 / $87.77
| Professional | | $29.27 | $58.28 | $87.77 |