- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.20 / $141.84 / $176.31
| Professional | | $45.20 | $141.84 | $176.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.09 / $57.66 / $262.33
| Professional | | $43.09 | $57.66 | $262.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.58 / $68.48 / $78.75
| Professional | | $59.58 | $68.48 | $78.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.92 / $41.36 / $48.26
| Professional | | $37.92 | $41.36 | $48.26 |
- 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
- $35.15 / $149.02 / $206.66
| Professional | | $35.15 | $149.02 | $206.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.64 / $141.65 / $12,000.00
| Professional | | $38.64 | $141.65 | $12,000.00 |