- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.78 / $44.78 / $181.00
| Professional | | $31.78 | $44.78 | $181.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.90 / $43.82 / $84.21
| Professional | | $34.90 | $43.82 | $84.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.66 / $52.41 / $61.78
| Professional | | $45.66 | $52.41 | $61.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.61 / $46.61 / $54.38
| Professional | | $39.61 | $46.61 | $54.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.51 / $43.82 / $53.16
| Professional | | $30.51 | $43.82 | $53.16 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.93 / $74.04 / $231.40
| Professional | | $31.93 | $74.04 | $231.40 |