- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.80 / $50.50 / $56.25
| Professional | | $41.80 | $50.50 | $56.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.06 / $49.02 / $68.98
| Professional | | $39.06 | $49.02 | $68.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.02 / $60.88 / $71.62
| Professional | | $58.02 | $60.88 | $71.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.71 / $60.71 / $77.27
| Professional | | $60.71 | $60.71 | $77.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $56.29 / $77.15
| Professional | | $12.88 | $56.29 | $77.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.55 / $45.59 / $77.33
| Professional | | $18.55 | $45.59 | $77.33 |