- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $22.06 / $28.29
| Professional | | $17.98 | $22.06 | $28.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $24.40 / $39.11
| Professional | | $17.00 | $24.40 | $39.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.08 / $27.68 / $31.40
| Professional | | $24.08 | $27.68 | $31.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.51 / $26.12 / $28.80
| Professional | | $18.51 | $26.12 | $28.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.70 / $22.37 / $30.95
| Professional | | $16.70 | $22.37 | $30.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.27 / $19.96 / $26.77
| Professional | | $17.27 | $19.96 | $26.77 |