- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.17 / $66.11 / $108.83
| Professional | | $40.17 | $66.11 | $108.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.98 / $81.09 / $129.88
| Professional | | $27.98 | $81.09 | $129.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.54 / $139.74 / $146.32
| Professional | | $118.54 | $139.74 | $146.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.84 / $63.87 / $135.07
| Professional | | $46.84 | $63.87 | $135.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.00 / $112.21 / $129.88
| Professional | | $32.00 | $112.21 | $129.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.61 / $78.88 / $95.79
| Professional | | $38.61 | $78.88 | $95.79 |