- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.94 / $22.14 / $29.25
| Professional | | $20.94 | $22.14 | $29.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.97 / $26.72 / $58.00
| Professional | | $18.97 | $26.72 | $58.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $35.40 / $39.34
| Professional | | $30.00 | $35.40 | $39.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.74 / $26.99 / $38.58
| Professional | | $24.74 | $26.99 | $38.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.50 / $30.41 / $40.19
| Professional | | $28.50 | $30.41 | $40.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.85 / $27.96 / $38.78
| Professional | | $20.85 | $27.96 | $38.78 |