- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.11 / $72.19 / $116.96
| Professional | | $60.11 | $72.19 | $116.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.41 / $90.70 / $90.70
| Professional | | $72.41 | $90.70 | $90.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.69 / $73.63 / $117.94
| Professional | | $51.69 | $73.63 | $117.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.81 / $87.07 / $101.58
| Professional | | $79.81 | $87.07 | $101.58 |
- 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
- $74.01 / $90.70 / $114.33
| Professional | | $74.01 | $90.70 | $114.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.19 / $64.73 / $108.77
| Professional | | $12.19 | $64.73 | $108.77 |