- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.64 / $67.38 / $95.50
| Professional | | $38.64 | $67.38 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.61 / $95.83 / $117.31
| Professional | | $57.61 | $95.83 | $117.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.06 / $97.72 / $142.46
| Professional | | $80.06 | $97.72 | $142.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.63 / $103.24 / $131.38
| Professional | | $56.63 | $103.24 | $131.38 |
- 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
- $100.02 / $117.31 / $146.60
| Professional | | $100.02 | $117.31 | $146.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $94.70 / $3,113.00
| Professional | | $29.27 | $94.70 | $3,113.00 |