- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.29 / $39.88 / $49.16
| Professional | | $32.29 | $39.88 | $49.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.78 / $37.97 / $56.64
| Professional | | $31.78 | $37.97 | $56.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.95 / $51.36 / $60.42
| Professional | | $48.95 | $51.36 | $60.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.84 / $49.84 / $55.70
| Professional | | $40.84 | $49.84 | $55.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.86 / $46.22 / $75.70
| Professional | | $22.86 | $46.22 | $75.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.44 / $42.43 / $65.13
| Professional | | $33.44 | $42.43 | $65.13 |