- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.92 / $65.53
| Professional | | $60.00 | $60.92 | $65.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.39 / $73.80 / $104.57
| Professional | | $45.39 | $73.80 | $104.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.00 / $47.79 / $57.55
| Professional | | $37.00 | $47.79 | $57.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.30 / $54.88 / $62.90
| Professional | | $50.30 | $54.88 | $62.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $49.50 / $65.53
| Professional | | $40.00 | $49.50 | $65.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.77 / $41.02 / $47.07
| Professional | | $38.77 | $41.02 | $47.07 |