- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.61 / $40.61 / $52.77
| Professional | | $40.61 | $40.61 | $52.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $41.09 / $49.31
| Professional | | $33.11 | $41.09 | $49.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.94 / $60.97 / $69.90
| Professional | | $52.94 | $60.97 | $69.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.39 / $34.84 / $41.09
| Professional | | $19.39 | $34.84 | $41.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.53 / $41.87 / $57.55
| Professional | | $33.53 | $41.87 | $57.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.69 / $31.14 / $63.29
| Professional | | $16.69 | $31.14 | $63.29 |