- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.26 / $41.60 / $51.34
| Professional | | $32.26 | $41.60 | $51.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $40.36 / $62.95
| Professional | | $29.74 | $40.36 | $62.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.20 / $53.70 / $63.18
| Professional | | $51.20 | $53.70 | $63.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.40 / $55.40 / $70.50
| Professional | | $55.40 | $55.40 | $70.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.44 / $54.11 / $62.95
| Professional | | $24.44 | $54.11 | $62.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.59 / $37.52 / $58.09
| Professional | | $20.59 | $37.52 | $58.09 |