- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $21.88 / $33.88
| Professional | | $14.13 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $31.62 / $47.86
| Professional | | $20.42 | $31.62 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $29.51 / $42.66
| Professional | | $25.12 | $29.51 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $28.18 / $34.67
| Professional | | $13.80 | $28.18 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $25.70 / $36.31
| Professional | | $16.98 | $25.70 | $36.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.68 / $19.95 / $37.15
| Professional | | $4.68 | $19.95 | $37.15 |