- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $602.56
| Professional | | $89.13 | $151.36 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $48.98 / $123.03
| Professional | | $34.67 | $48.98 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $158.49
| Professional | | $95.50 | $134.90 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $95.50 / $138.04
| Professional | | $81.28 | $95.50 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $46.77 / $162.18
| Professional | | $41.69 | $46.77 | $162.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $165.96
| Professional | | $83.18 | $120.23 | $165.96 |