- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.67 / $45.91 / $50.96
| Professional | | $37.67 | $45.91 | $50.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.24 / $41.26 / $62.48
| Professional | | $33.24 | $41.26 | $62.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.51 / $60.71 / $60.71
| Professional | | $51.51 | $60.71 | $60.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.98 / $59.98 / $69.97
| Professional | | $54.98 | $59.98 | $69.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.01 / $51.88 / $62.48
| Professional | | $31.01 | $51.88 | $62.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.17 / $37.54 / $45.59
| Professional | | $17.17 | $37.54 | $45.59 |