- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.65 / $49.11 / $91.21
| Professional | | $30.65 | $49.11 | $91.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.73 / $70.73 / $70.73
| Professional | | $70.73 | $70.73 | $70.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.80 / $69.55 / $99.93
| Professional | | $64.80 | $69.55 | $99.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.15 / $48.01 / $79.23
| Professional | | $41.15 | $48.01 | $79.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.73 / $87.15 / $87.15
| Professional | | $70.73 | $87.15 | $87.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.67 / $68.42 / $95.52
| Professional | | $43.67 | $68.42 | $95.52 |