- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $42.90 / $55.51
| Professional | | $30.00 | $42.90 | $55.51 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.07 / $18.39 / $22.65
| Professional | 52 | $14.07 | $18.39 | $22.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.44 / $35.67 / $55.51
| Professional | | $26.44 | $35.67 | $55.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.58 / $47.82 / $56.26
| Professional | | $45.58 | $47.82 | $56.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.85 / $48.85 / $62.17
| Professional | | $48.85 | $48.85 | $62.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.49 / $45.30 / $55.51
| Professional | | $23.49 | $45.30 | $55.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.28 / $33.15 / $51.48
| Professional | | $20.28 | $33.15 | $51.48 |