- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.40 / $23.08 / $32.09
| Professional | | $14.40 | $23.08 | $32.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.07 / $65.19 / $107.04
| Professional | | $36.07 | $65.19 | $107.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.79 / $34.49 / $40.65
| Professional | | $31.79 | $34.49 | $40.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.65 / $43.54 / $47.33
| Professional | | $41.65 | $43.54 | $47.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.80 / $37.00 / $59.57
| Professional | | $26.80 | $37.00 | $59.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.72 / $48.89 / $250.00
| Professional | | $32.72 | $48.89 | $250.00 |