- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $40.08 / $46.55
| Professional | | $32.28 | $40.08 | $46.55 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.08 / $17.07 / $20.05
| Professional | 52 | $14.08 | $17.07 | $20.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.99 / $31.32 / $46.55
| Professional | | $26.99 | $31.32 | $46.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.75 / $65.13 / $73.31
| Professional | | $56.75 | $65.13 | $73.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.24 / $40.96 / $48.06
| Professional | | $35.24 | $40.96 | $48.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.01 / $42.88 / $61.59
| Professional | | $36.01 | $42.88 | $61.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.04 / $42.88 / $67.36
| Professional | | $29.04 | $42.88 | $67.36 |