- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $199.53 / $281.84
| Professional | | $147.91 | $199.53 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $257.04 / $758.58
| Professional | | $165.96 | $257.04 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $389.05
| Professional | | $263.03 | $309.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $323.59
| Professional | | $162.18 | $234.42 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $346.74
| Professional | | $151.36 | $234.42 | $346.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $1,412.54 / $3,981.07
| Professional | | $204.17 | $1,412.54 | $3,981.07 |