- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.63 / $35.25 / $44.91
| Professional | | $31.63 | $35.25 | $44.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.84 / $34.46 / $55.05
| Professional | | $26.84 | $34.46 | $55.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.06 / $49.41 / $55.64
| Professional | | $43.06 | $49.41 | $55.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.44 / $48.44 / $61.66
| Professional | | $48.44 | $48.44 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.32 / $47.56 / $61.04
| Professional | | $26.32 | $47.56 | $61.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.76 / $41.92 / $52.77
| Professional | | $15.76 | $41.92 | $52.77 |