- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $186.21 / $380.19
| Professional | | $154.88 | $186.21 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $380.19 / $891.25
| Professional | | $223.87 | $380.19 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $389.05
| Professional | | $218.78 | $331.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $218.78 / $257.04
| Professional | | $199.53 | $218.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $74.13 / $85.11
| Professional | 26 | $67.61 | $74.13 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $371.54 / $537.03
| Professional | | $181.97 | $371.54 | $537.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $416.87
| Professional | | $162.18 | $218.78 | $416.87 |