- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $46.70 / $62.83
| Professional | | $40.00 | $46.70 | $62.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $68.93 / $104.57
| Professional | | $45.00 | $68.93 | $104.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.27 / $39.14 / $45.01
| Professional | | $33.27 | $39.14 | $45.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.32 / $40.72 / $48.74
| Professional | | $37.32 | $40.72 | $48.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $36.00 / $50.78
| Professional | | $35.47 | $36.00 | $50.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.72 / $36.08 / $49.24
| Professional | | $29.72 | $36.08 | $49.24 |