- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $70.64 / $77.34
| Professional | | $17.70 | $70.64 | $77.34 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $72.31 / $72.31 / $76.20
| Professional | 25 | $72.31 | $72.31 | $76.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.28 / $145.28 / $176.40
| Professional | | $145.28 | $145.28 | $176.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.37 / $88.35 / $108.61
| Professional | | $84.37 | $88.35 | $108.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.72 / $89.66 / $93.40
| Professional | | $74.72 | $89.66 | $93.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.89 / $93.40 / $109.94
| Professional | | $74.89 | $93.40 | $109.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.34 / $61.13 / $83.43
| Professional | | $50.34 | $61.13 | $83.43 |