- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.30 / $21.65 / $33.61
| Professional | | $17.30 | $21.65 | $33.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.80 / $33.43 / $40.96
| Professional | | $22.80 | $33.43 | $40.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.19 / $33.71 / $33.71
| Professional | | $32.19 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.82 / $36.04 / $40.96
| Professional | | $26.82 | $36.04 | $40.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.49 / $35.39 / $41.66
| Professional | | $29.49 | $35.39 | $41.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.74 / $27.74 / $27.74
| Professional | | $27.74 | $27.74 | $27.74 |