- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $25.70 / $46.77
| Professional | | $18.20 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $19.05 / $35.48
| Professional | | $13.18 | $19.05 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $63.10 / $74.13
| Professional | | $56.23 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $31.62 / $34.67
| Professional | | $18.62 | $31.62 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $26.30 / $35.48
| Professional | | $14.79 | $26.30 | $35.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $25.12 / $35.48
| Professional | | $18.20 | $25.12 | $35.48 |