- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $76.51 / $148.02
| Professional | | $51.00 | $76.51 | $148.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.39 / $113.25 / $135.90
| Professional | | $84.39 | $113.25 | $135.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.84 / $93.22 / $119.73
| Professional | | $78.84 | $93.22 | $119.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.55 / $96.04 / $113.25
| Professional | | $57.55 | $96.04 | $113.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.41 / $110.33 / $131.27
| Professional | | $73.41 | $110.33 | $131.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $65.89 / $114.47
| Professional | | $29.27 | $65.89 | $114.47 |