- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.71 / $120.80 / $178.05
| Professional | | $36.71 | $120.80 | $178.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.26 / $157.47 / $336.26
| Professional | | $42.26 | $157.47 | $336.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.95 / $74.04 / $255.64
| Professional | | $62.95 | $74.04 | $255.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $175.44 / $240.80
| Professional | | $45.71 | $175.44 | $240.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.94 / $215.00 / $269.31
| Professional | | $137.94 | $215.00 | $269.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.52 / $54.85 / $242.29
| Professional | | $30.52 | $54.85 | $242.29 |