- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.28 / $104.61 / $109.43
| Professional | | $71.28 | $104.61 | $109.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.58 / $80.92 / $118.03
| Professional | | $60.58 | $80.92 | $118.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.50 / $133.21 / $166.51
| Professional | | $122.50 | $133.21 | $166.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.42 / $86.17 / $93.66
| Professional | | $82.42 | $86.17 | $93.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.43 / $93.66 / $117.78
| Professional | | $76.43 | $93.66 | $117.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.96 / $53.16 / $130.24
| Professional | | $38.96 | $53.16 | $130.24 |