- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.53 / $43.82 / $53.23
| Professional | | $33.53 | $43.82 | $53.23 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $16.77 / $21.91 / $26.62
| Professional | 52 | $16.77 | $21.91 | $26.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.55 / $42.52 / $65.26
| Professional | | $31.55 | $42.52 | $65.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.01 / $56.66 / $66.66
| Professional | | $54.01 | $56.66 | $66.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.43 / $57.43 / $73.09
| Professional | | $57.43 | $57.43 | $73.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.63 / $53.25 / $66.00
| Professional | | $26.63 | $53.25 | $66.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.52 / $47.11 / $77.63
| Professional | | $26.52 | $47.11 | $77.63 |