- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.76 / $26.11 / $38.36
| Professional | | $18.76 | $26.11 | $38.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.70 / $29.42 / $39.04
| Professional | | $24.70 | $29.42 | $39.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.90 / $68.77 / $76.41
| Professional | | $61.90 | $68.77 | $76.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.28 / $30.69 / $38.88
| Professional | | $27.28 | $30.69 | $38.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.97 / $34.71 / $46.17
| Professional | | $24.97 | $34.71 | $46.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.13 / $25.65 / $30.18
| Professional | | $21.13 | $25.65 | $30.18 |