- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.93 / $52.00 / $64.50
| Professional | | $35.93 | $52.00 | $64.50 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $17.97 / $29.42 / $37.09
| Professional | 52 | $17.97 | $29.42 | $37.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.89 / $47.61 / $57.14
| Professional | | $23.89 | $47.61 | $57.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.63 / $117.80 / $154.69
| Professional | | $102.63 | $117.80 | $154.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.85 / $45.71 / $53.33
| Professional | | $38.85 | $45.71 | $53.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.97 / $47.61 / $85.76
| Professional | | $34.97 | $47.61 | $85.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.52 / $56.06 / $108.58
| Professional | | $37.52 | $56.06 | $108.58 |