- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.53 / $46.55 / $93.82
| Professional | | $34.53 | $46.55 | $93.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.89 / $72.65 / $87.18
| Professional | | $56.89 | $72.65 | $87.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.70 / $57.60 / $87.52
| Professional | | $47.70 | $57.60 | $87.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.26 / $61.61 / $72.65
| Professional | | $33.26 | $61.61 | $72.65 |
- 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
- $57.08 / $72.65 / $87.69
| Professional | | $57.08 | $72.65 | $87.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.60 / $41.56 / $77.52
| Professional | | $27.60 | $41.56 | $77.52 |