- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.75 / $42.28 / $43.30
| Professional | | $40.75 | $42.28 | $43.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $28.87 / $46.81
| Professional | | $28.87 | $28.87 | $46.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.31 / $44.31 / $44.31
| Professional | | $44.31 | $44.31 | $44.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $670.00
| Professional | | $5.00 | $5.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.90 / $40.53 / $60.80
| Professional | | $37.90 | $40.53 | $60.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.85 / $26.53 / $36.72
| Professional | | $21.85 | $26.53 | $36.72 |