- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.17 / $22.38 / $28.57
| Professional | | $16.17 | $22.38 | $28.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.12 / $34.24 / $35.09
| Professional | | $21.12 | $34.24 | $35.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.63 / $34.13 / $40.35
| Professional | | $29.63 | $34.13 | $40.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.65 / $30.88 / $35.09
| Professional | | $21.65 | $30.88 | $35.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.63 / $35.09 / $43.41
| Professional | | $28.63 | $35.09 | $43.41 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.79 / $25.28 / $37.94
| Professional | | $16.79 | $25.28 | $37.94 |