- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.98 / $28.33 / $34.06
| Professional | | $25.98 | $28.33 | $34.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.79 / $32.04 / $47.11
| Professional | | $21.79 | $32.04 | $47.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.98 / $67.75 / $80.88
| Professional | | $60.98 | $67.75 | $80.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.75 / $35.00 / $40.84
| Professional | | $29.75 | $35.00 | $40.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.25 / $36.46 / $55.20
| Professional | | $26.25 | $36.46 | $55.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.10 / $36.34 / $51.25
| Professional | | $27.10 | $36.34 | $51.25 |