- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.26 / $44.94 / $64.56
| Professional | | $32.26 | $44.94 | $64.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.44 / $43.61 / $79.20
| Professional | | $26.44 | $43.61 | $79.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.05 / $67.23 / $79.09
| Professional | | $64.05 | $67.23 | $79.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.70 / $69.70 / $88.70
| Professional | | $69.70 | $69.70 | $88.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.13 / $60.15 / $79.20
| Professional | | $29.13 | $60.15 | $79.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $40.54 / $85.75
| Professional | | $4.20 | $40.54 | $85.75 |