- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.71 / $27.81 / $31.01
| Professional | | $24.71 | $27.81 | $31.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.41 / $44.36 / $158.19
| Professional | | $21.41 | $44.36 | $158.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.00 / $42.46 / $50.06
| Professional | | $37.00 | $42.46 | $50.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.61 / $42.59 / $49.69
| Professional | | $37.61 | $42.59 | $49.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.76 / $38.00 / $53.00
| Professional | | $21.76 | $38.00 | $53.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.25 / $38.33 / $69.36
| Professional | | $26.25 | $38.33 | $69.36 |