- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.91 / $45.39 / $59.28
| Professional | | $31.91 | $45.39 | $59.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.57 / $38.29 / $45.96
| Professional | | $30.57 | $38.29 | $45.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.02 / $66.69 / $78.25
| Professional | | $58.02 | $66.69 | $78.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.39 / $32.47 / $38.29
| Professional | | $19.39 | $32.47 | $38.29 |
- 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
- $31.25 / $38.29 / $60.48
| Professional | | $31.25 | $38.29 | $60.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.35 / $37.15 / $68.76
| Professional | | $16.35 | $37.15 | $68.76 |