- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.85 / $325.07 / $464.50
| Professional | | $190.85 | $325.07 | $464.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.02 / $235.89 / $496.98
| Professional | | $182.02 | $235.89 | $496.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.02 / $304.67 / $424.63
| Professional | | $138.02 | $304.67 | $424.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.88 / $232.80 / $271.60
| Professional | | $197.88 | $232.80 | $271.60 |
- 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
- $193.02 / $242.50 / $417.81
| Professional | | $193.02 | $242.50 | $417.81 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.91 / $4,824.31 / $23,625.00
| Professional | | $178.91 | $4,824.31 | $23,625.00 |