- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.66 / $38.28 / $57.79
| Professional | | $28.66 | $38.28 | $57.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.42 / $67.25 / $103.32
| Professional | | $48.42 | $67.25 | $103.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.45 / $74.45 / $74.45
| Professional | | $74.45 | $74.45 | $74.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.05 / $48.42 / $64.56
| Professional | | $29.05 | $48.42 | $64.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.88 / $67.25 / $80.04
| Professional | | $54.88 | $67.25 | $80.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.61 / $58.48 / $59.51
| Professional | | $43.61 | $58.48 | $59.51 |