- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $36.31 / $47.86
| Professional | | $25.70 | $36.31 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $35.48 / $47.86
| Professional | | $26.30 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $50.12 / $56.23
| Professional | | $45.71 | $50.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $69.18
| Professional | | $50.12 | $50.12 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $40.74 / $54.95
| Professional | | $14.45 | $40.74 | $54.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $44.67 / $53.70
| Professional | | $20.42 | $44.67 | $53.70 |