- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $41.69 / $54.95
| Professional | | $25.12 | $41.69 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $51.29 / $70.79
| Professional | | $30.90 | $51.29 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $61.66 / $69.18
| Professional | | $54.95 | $61.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $28.18 / $35.48
| Professional | | $24.55 | $28.18 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $54.95 / $69.18
| Professional | | $25.12 | $54.95 | $69.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $53.70 / $13,182.57
| Professional | | $27.54 | $53.70 | $13,182.57 |