- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.56 / $83.58 / $292.00
| Professional | | $67.56 | $83.58 | $292.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.00 / $100.54 / $152.15
| Professional | | $73.00 | $100.54 | $152.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.81 / $93.39 / $113.97
| Professional | | $77.81 | $93.39 | $113.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.47 / $96.52 / $112.60
| Professional | | $88.47 | $96.52 | $112.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.59 / $92.13 / $115.58
| Professional | | $70.59 | $92.13 | $115.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.45 / $70.43 / $86.92
| Professional | | $52.45 | $70.43 | $86.92 |