- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.52 / $41.36 / $46.02
| Professional | | $34.52 | $41.36 | $46.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.46 / $93.46 / $144.43
| Professional | | $93.46 | $93.46 | $144.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.08 / $52.44 / $61.80
| Professional | | $50.08 | $52.44 | $61.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.09 / $48.11 / $50.11
| Professional | | $40.09 | $48.11 | $50.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.78 / $50.11 / $69.77
| Professional | | $48.78 | $50.11 | $69.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.56 / $39.53 / $53.95
| Professional | | $32.56 | $39.53 | $53.95 |