- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.14 / $34.32 / $34.84
| Professional | | $21.14 | $34.32 | $34.84 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $10.57 / $13.94 / $17.16
| Professional | 52 | $10.57 | $13.94 | $17.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.52 / $27.00 / $42.04
| Professional | | $19.52 | $27.00 | $42.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.72 / $36.44 / $42.87
| Professional | | $34.72 | $36.44 | $42.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.99 / $36.99 / $47.08
| Professional | | $36.99 | $36.99 | $47.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.23 / $34.29 / $42.04
| Professional | | $17.23 | $34.29 | $42.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.65 / $32.75 / $48.76
| Professional | | $20.65 | $32.75 | $48.76 |