- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.91 / $142.18 / $511.00
| Professional | | $82.91 | $142.18 | $511.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.81 / $120.89 / $120.89
| Professional | | $102.81 | $120.89 | $120.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.42 / $145.46 / $2,342.00
| Professional | | $126.42 | $145.46 | $2,342.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.38 / $116.05 / $135.38
| Professional | | $106.38 | $116.05 | $135.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.64 / $120.89 / $160.02
| Professional | | $98.64 | $120.89 | $160.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.61 / $131.93 / $3,956.00
| Professional | | $19.61 | $131.93 | $3,956.00 |