- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.49 / $44.54 / $84.48
| Professional | | $42.49 | $44.54 | $84.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.94 / $67.33 / $80.79
| Professional | | $54.94 | $67.33 | $80.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.93 / $65.79 / $2,518.19
| Professional | | $59.93 | $65.79 | $2,518.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.75 / $63.55 / $70.02
| Professional | | $54.75 | $63.55 | $70.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.21 / $67.33 / $139.30
| Professional | | $53.21 | $67.33 | $139.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $47.52 / $62.06
| Professional | | $8.94 | $47.52 | $62.06 |