- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.16 / $23.30 / $144.00
| Professional | | $9.16 | $23.30 | $144.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.72 / $11.72 / $29.09
| Professional | | $11.72 | $11.72 | $29.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.62 / $19.14 / $34.40
| Professional | | $16.62 | $19.14 | $34.40 |
- 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
- $26.87 / $45.26 / $47.31
| Professional | | $26.87 | $45.26 | $47.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.56 / $24.13 / $37.04
| Professional | | $8.56 | $24.13 | $37.04 |