- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.77 / $37.70 / $48.68
| Professional | | $29.77 | $37.70 | $48.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.88 / $38.04 / $45.66
| Professional | | $29.88 | $38.04 | $45.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.27 / $55.29 / $62.42
| Professional | | $47.27 | $55.29 | $62.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.22 / $32.27 / $38.04
| Professional | | $21.22 | $32.27 | $38.04 |
- 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
- $31.05 / $38.04 / $50.24
| Professional | | $31.05 | $38.04 | $50.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.43 / $33.29 / $61.63
| Professional | | $17.43 | $33.29 | $61.63 |