- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.12 / $37.60 / $52.62
| Professional | | $29.12 | $37.60 | $52.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.13 / $55.98 / $73.84
| Professional | | $35.13 | $55.98 | $73.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.64 / $50.31 / $79.84
| Professional | | $40.64 | $50.31 | $79.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.96 / $64.98 / $82.70
| Professional | | $26.96 | $64.98 | $82.70 |
- 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
- $60.25 / $73.84 / $89.21
| Professional | | $60.25 | $73.84 | $89.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.03 / $34.68 / $85.81
| Professional | | $23.03 | $34.68 | $85.81 |