- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.84 / $41.47 / $44.66
| Professional | | $27.84 | $41.47 | $44.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.02 / $38.08 / $55.60
| Professional | | $27.02 | $38.08 | $55.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.36 / $74.40 / $82.30
| Professional | | $15.36 | $74.40 | $82.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.39 / $40.46 / $47.21
| Professional | | $34.39 | $40.46 | $47.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.35 / $42.15 / $62.57
| Professional | | $30.35 | $42.15 | $62.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.33 / $39.86 / $72.91
| Professional | | $27.33 | $39.86 | $72.91 |