- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.17 / $72.08 / $95.92
| Professional | | $67.17 | $72.08 | $95.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.69 / $103.10 / $134.25
| Professional | | $68.69 | $103.10 | $134.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.40 / $92.23 / $108.83
| Professional | | $78.40 | $92.23 | $108.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.03 / $118.14 / $134.25
| Professional | | $110.03 | $118.14 | $134.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.48 / $109.55 / $148.85
| Professional | | $83.48 | $109.55 | $148.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.20 / $120.42 / $184.94
| Professional | | $93.20 | $120.42 | $184.94 |