- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.94 / $16.92 / $24.89
| Professional | | $9.94 | $16.92 | $24.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.74 / $21.71 / $47.82
| Professional | | $12.74 | $21.71 | $47.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.04 / $31.16 / $37.33
| Professional | | $28.04 | $31.16 | $37.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.00 / $670.00 / $670.00
| Professional | | $670.00 | $670.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.52 / $32.03 / $41.57
| Professional | | $20.52 | $32.03 | $41.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.32 / $23.24 / $23.65
| Professional | | $17.32 | $23.24 | $23.65 |