- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.87 / $33.18 / $43.40
| Professional | | $21.87 | $33.18 | $43.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.86 / $47.26 / $71.08
| Professional | | $30.86 | $47.26 | $71.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.52 / $43.45 / $60.53
| Professional | | $36.52 | $43.45 | $60.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.63 / $42.21 / $48.73
| Professional | | $24.63 | $42.21 | $48.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.13 / $47.96 / $63.18
| Professional | | $39.13 | $47.96 | $63.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.62 / $29.27 / $52.54
| Professional | | $6.62 | $29.27 | $52.54 |