- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.16 / $76.95 / $83.77
| Professional | | $65.16 | $76.95 | $83.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.11 / $67.84 / $102.66
| Professional | | $60.11 | $67.84 | $102.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.75 / $93.10 / $109.53
| Professional | | $88.75 | $93.10 | $109.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.34 / $90.34 / $114.98
| Professional | | $90.34 | $90.34 | $114.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.42 / $88.70 / $113.42
| Professional | | $45.42 | $88.70 | $113.42 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.60 / $69.05 / $125.45
| Professional | | $13.60 | $69.05 | $125.45 |