- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.28 / $53.74 / $57.03
| Professional | | $46.28 | $53.74 | $57.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.81 / $80.80 / $96.96
| Professional | | $69.81 | $80.80 | $96.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.05 / $87.14 / $1,973.00
| Professional | | $75.05 | $87.14 | $1,973.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.12 / $71.09 / $80.80
| Professional | | $53.12 | $71.09 | $80.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.06 / $77.39 / $102.53
| Professional | | $59.06 | $77.39 | $102.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $57.03 / $104.84
| Professional | | $29.27 | $57.03 | $104.84 |