- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.58 / $46.12 / $85.31
| Professional | | $37.58 | $46.12 | $85.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.07 / $35.07 / $51.25
| Professional | | $35.07 | $35.07 | $51.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $104.71 / $104.71
| Professional | | $100.00 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.23 / $65.23 / $65.23
| Professional | | $65.23 | $65.23 | $65.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.54 / $51.25 / $74.70
| Professional | | $28.54 | $51.25 | $74.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.82 / $40.79 / $44.35
| Professional | | $38.82 | $40.79 | $44.35 |