- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.13 / $173.82 / $269.17
| Professional | | $146.13 | $173.82 | $269.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.87 / $123.41 / $211.32
| Professional | | $90.87 | $123.41 | $211.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.47 / $111.10 / $135.90
| Professional | | $46.47 | $111.10 | $135.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.78 / $52.13 / $60.82
| Professional | | $47.78 | $52.13 | $60.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.61 / $328.39 / $466.28
| Professional | | $94.61 | $328.39 | $466.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.65 / $66.84 / $154.07
| Professional | | $38.65 | $66.84 | $154.07 |