- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.81 / $34.92 / $40.36
| Professional | | $27.81 | $34.92 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.13 / $33.86 / $49.48
| Professional | | $26.13 | $33.86 | $49.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.56 / $43.61 / $51.31
| Professional | | $41.56 | $43.61 | $51.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.54 / $43.54 / $55.41
| Professional | | $43.54 | $43.54 | $55.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.87 / $42.75 / $53.00
| Professional | | $22.87 | $42.75 | $53.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.25 / $31.47 / $50.87
| Professional | | $17.25 | $31.47 | $50.87 |