- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.53 / $44.56 / $54.74
| Professional | | $33.53 | $44.56 | $54.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.77 / $22.28 / $27.37
| Professional | 52 | $16.77 | $22.28 | $27.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.25 / $43.25 / $67.13
| Professional | | $31.25 | $43.25 | $67.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.22 / $57.94 / $68.17
| Professional | | $55.22 | $57.94 | $68.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.07 / $59.07 / $75.18
| Professional | | $59.07 | $59.07 | $75.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.23 / $54.77 / $67.13
| Professional | | $26.23 | $54.77 | $67.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.42 / $53.92 / $85.89
| Professional | | $30.42 | $53.92 | $85.89 |