- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $34.77 / $50.05
| Professional | | $28.59 | $34.77 | $50.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $31.32 / $46.03
| Professional | | $21.05 | $31.32 | $46.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.20 / $48.53 / $55.81
| Professional | | $43.20 | $48.53 | $55.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.19 / $40.50 / $47.99
| Professional | | $35.19 | $40.50 | $47.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.35 / $39.77 / $47.09
| Professional | | $33.35 | $39.77 | $47.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $33.31 / $48.60
| Professional | | $27.43 | $33.31 | $48.60 |