- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.28 / $33.88 / $55.57
| Professional | | $20.28 | $33.88 | $55.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.77 / $37.15 / $74.26
| Professional | | $23.77 | $37.15 | $74.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.53 / $47.25 / $56.60
| Professional | | $42.53 | $47.25 | $56.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.20 / $670.00 / $670.00
| Professional | | $47.20 | $670.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.50 / $49.76 / $66.22
| Professional | | $32.50 | $49.76 | $66.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.71 / $23.93 / $32.65
| Professional | | $19.71 | $23.93 | $32.65 |