- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.53 / $51.41 / $90.67
| Professional | | $41.53 | $51.41 | $90.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.59 / $69.08 / $120.84
| Professional | | $48.59 | $69.08 | $120.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.89 / $75.43 / $90.38
| Professional | | $67.89 | $75.43 | $90.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.20 / $670.00 / $670.00
| Professional | | $55.20 | $670.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.35 / $80.93 / $110.17
| Professional | | $57.35 | $80.93 | $110.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.67 / $55.88 / $56.86
| Professional | | $41.67 | $55.88 | $56.86 |