- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $26.30 / $39.42
| Professional | | $17.02 | $26.30 | $39.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.30 / $38.27 / $71.04
| Professional | | $24.30 | $38.27 | $71.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.75 / $51.36 / $60.55
| Professional | | $44.75 | $51.36 | $60.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.41 / $27.64 / $32.24
| Professional | | $24.41 | $27.64 | $32.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.07 / $29.95 / $50.87
| Professional | | $24.07 | $29.95 | $50.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $24.86 / $75.58
| Professional | | $15.00 | $24.86 | $75.58 |