- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.09 / $57.97 / $222.12
| Professional | | $52.09 | $57.97 | $222.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.33 / $66.54 / $91.04
| Professional | | $60.33 | $66.54 | $91.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.64 / $78.90 / $90.74
| Professional | | $68.64 | $78.90 | $90.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.09 / $57.91 / $67.56
| Professional | | $53.09 | $57.91 | $67.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.23 / $70.62 / $90.26
| Professional | | $49.23 | $70.62 | $90.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.20 / $73.23 / $12,600.00
| Professional | | $50.20 | $73.23 | $12,600.00 |