- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.61 / $84.75 / $98.20
| Professional | | $70.61 | $84.75 | $98.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.17 / $79.08 / $114.05
| Professional | | $69.17 | $79.08 | $114.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.18 / $101.96 / $119.95
| Professional | | $97.18 | $101.96 | $119.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.10 / $100.36 / $120.14
| Professional | | $88.10 | $100.36 | $120.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.39 / $114.05 / $135.15
| Professional | | $73.39 | $114.05 | $135.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.73 / $98.77 / $145.44
| Professional | | $68.73 | $98.77 | $145.44 |