- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.72 / $62.04 / $69.59
| Professional | | $47.72 | $62.04 | $69.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.79 / $76.70 / $98.50
| Professional | | $57.79 | $76.70 | $98.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.34 / $90.86 / $104.90
| Professional | | $74.34 | $90.86 | $104.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.89 / $86.68 / $110.32
| Professional | | $49.89 | $86.68 | $110.32 |
- 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
- $80.38 / $98.50 / $114.78
| Professional | | $80.38 | $98.50 | $114.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.58 / $62.13 / $110.21
| Professional | | $41.58 | $62.13 | $110.21 |