- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.20 / $62.83 / $67.22
| Professional | | $47.20 | $62.83 | $67.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.97 / $53.71 / $82.46
| Professional | | $42.97 | $53.71 | $82.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.47 / $71.83 / $84.51
| Professional | | $68.47 | $71.83 | $84.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.56 / $72.56 / $92.36
| Professional | | $72.56 | $72.56 | $92.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.89 / $71.25 / $83.96
| Professional | | $32.89 | $71.25 | $83.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.98 / $49.95 / $86.96
| Professional | | $40.98 | $49.95 | $86.96 |