- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.73 / $19.87 / $39.50
| Professional | | $16.73 | $19.87 | $39.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $20.49 / $28.93
| Professional | | $19.64 | $20.49 | $28.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $27.58 / $33.11
| Professional | | $13.00 | $27.58 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.60 / $27.77 / $32.40
| Professional | | $23.60 | $27.77 | $32.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.91 / $28.93 / $31.01
| Professional | | $18.91 | $28.93 | $31.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.55 / $18.55 / $19.07
| Professional | | $18.55 | $18.55 | $19.07 |