- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $47.86 / $85.11
| Professional | | $25.70 | $47.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | 50 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $64.57 / $91.20
| Professional | | $41.69 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $66.07 / $87.10
| Professional | | $53.70 | $66.07 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $69.18 / $89.13
| Professional | | $25.12 | $69.18 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $52.48 / $83.18
| Professional | | $22.39 | $52.48 | $83.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $34.67 / $91.20
| Professional | | $23.44 | $34.67 | $91.20 |