- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.38 / $124.84 / $156.41
| Professional | | $73.38 | $124.84 | $156.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.28 / $94.43 / $207.07
| Professional | | $64.28 | $94.43 | $207.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.57 / $268.60 / $331.51
| Professional | | $26.57 | $268.60 | $331.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.09 / $90.65 / $105.76
| Professional | | $83.09 | $90.65 | $105.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.16 / $94.43 / $124.72
| Professional | | $67.16 | $94.43 | $124.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.45 / $92.07 / $226.56
| Professional | | $67.45 | $92.07 | $226.56 |