- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.64 / $35.74 / $44.49
| Professional | | $28.64 | $35.74 | $44.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.86 / $56.94 / $68.33
| Professional | | $42.86 | $56.94 | $68.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.97 / $53.18 / $66.73
| Professional | | $44.97 | $53.18 | $66.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.07 / $48.28 / $56.94
| Professional | | $30.07 | $48.28 | $56.94 |
- 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
- $46.46 / $56.94 / $70.56
| Professional | | $46.46 | $56.94 | $70.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.65 / $38.77 / $69.52
| Professional | | $24.65 | $38.77 | $69.52 |