- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.03 / $41.00 / $55.72
| Professional | | $20.03 | $41.00 | $55.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $36.03 / $52.23
| Professional | | $20.00 | $36.03 | $52.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.66 / $42.21 / $45.87
| Professional | | $31.66 | $42.21 | $45.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.78 / $30.94 / $40.00
| Professional | | $23.78 | $30.94 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.48 / $40.00 / $45.20
| Professional | | $26.48 | $40.00 | $45.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.76 / $24.57 / $33.24
| Professional | | $21.76 | $24.57 | $33.24 |