- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.63 / $39.15 / $47.39
| Professional | | $31.63 | $39.15 | $47.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.35 / $35.15 / $53.19
| Professional | | $28.35 | $35.15 | $53.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.20 / $88.17 / $88.17
| Professional | | $84.20 | $88.17 | $88.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.81 / $51.06 / $59.57
| Professional | | $46.81 | $51.06 | $59.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.89 / $45.95 / $53.19
| Professional | | $32.89 | $45.95 | $53.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.00 / $38.86 / $72.78
| Professional | | $32.00 | $38.86 | $72.78 |