- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.39 / $95.66 / $130.00
| Professional | | $73.39 | $95.66 | $130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.00 / $89.59 / $130.94
| Professional | | $61.00 | $89.59 | $130.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.99 / $123.98 / $136.38
| Professional | | $92.99 | $123.98 | $136.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.12 / $109.49 / $125.95
| Professional | | $82.12 | $109.49 | $125.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.00 / $100.45 / $143.52
| Professional | | $86.00 | $100.45 | $143.52 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.18 / $84.86 / $141.57
| Professional | | $84.18 | $84.86 | $141.57 |