- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.13 / $51.27 / $56.75
| Professional | | $45.13 | $51.27 | $56.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.78 / $68.98 / $122.12
| Professional | | $51.78 | $68.98 | $122.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.23 / $76.02 / $89.62
| Professional | | $66.23 | $76.02 | $89.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.92 / $71.23 / $83.10
| Professional | | $62.92 | $71.23 | $83.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.46 / $69.90 / $93.15
| Professional | | $44.46 | $69.90 | $93.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.02 / $64.04 / $118.30
| Professional | | $52.02 | $64.04 | $118.30 |