- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $19.72 / $23.93
| Professional | | $16.22 | $19.72 | $23.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.05 / $18.82 / $27.85
| Professional | | $16.05 | $18.82 | $27.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.08 / $25.26 / $29.72
| Professional | | $24.08 | $25.26 | $29.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.83 / $24.51 / $28.41
| Professional | | $20.83 | $24.51 | $28.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $27.85 / $32.13
| Professional | | $16.89 | $27.85 | $32.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.76 / $23.18 / $34.79
| Professional | | $16.76 | $23.18 | $34.79 |