- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.64 / $53.46 / $74.05
| Professional | | $43.64 | $53.46 | $74.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.02 / $73.09 / $210.20
| Professional | | $53.02 | $73.09 | $210.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.55 / $151.65 / $159.31
| Professional | | $11.55 | $151.65 | $159.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.10 / $62.38 / $72.77
| Professional | | $55.10 | $62.38 | $72.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.81 / $11.10 / $12.95
| Professional | 26 | $9.81 | $11.10 | $12.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.39 / $62.79 / $103.46
| Professional | | $48.39 | $62.79 | $103.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.02 / $64.17 / $125.03
| Professional | | $47.02 | $64.17 | $125.03 |