- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.54 / $42.28 / $53.33
| Professional | | $31.54 | $42.28 | $53.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.45 / $48.85 / $85.29
| Professional | | $36.45 | $48.85 | $85.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.19 / $63.50 / $81.91
| Professional | | $55.19 | $63.50 | $81.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.32 / $56.84 / $66.31
| Professional | | $48.32 | $56.84 | $66.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.56 / $49.47 / $60.77
| Professional | | $32.56 | $49.47 | $60.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.10 / $50.85 / $73.23
| Professional | | $7.10 | $50.85 | $73.23 |