- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.72 / $81.67 / $182.30
| Professional | | $59.72 | $81.67 | $182.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.17 / $107.87 / $138.54
| Professional | | $82.17 | $107.87 | $138.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.99 / $78.91 / $148.53
| Professional | | $48.99 | $78.91 | $148.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.91 / $133.00 / $155.16
| Professional | | $121.91 | $133.00 | $155.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.27 / $49.38 / $57.61
| Professional | 26 | $45.27 | $49.38 | $57.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.50 / $137.59 / $181.37
| Professional | | $109.50 | $137.59 | $181.37 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.09 / $115.03 / $152.91
| Professional | | $73.09 | $115.03 | $152.91 |