- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $42.66 / $57.54
| Professional | | $33.88 | $42.66 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $47.86 / $177.83
| Professional | | $36.31 | $47.86 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $64.57 / $2,344.23
| Professional | | $54.95 | $64.57 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $64.57 / $79.43
| Professional | | $53.70 | $64.57 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $69.18
| Professional | | $32.36 | $50.12 | $69.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $51.29 / $72.44
| Professional | | $7.08 | $51.29 | $72.44 |