- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $16.14 / $17.80
| Professional | | $13.36 | $16.14 | $17.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.11 / $21.13 / $71.94
| Professional | | $16.11 | $21.13 | $71.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.14 / $19.69 / $22.16
| Professional | | $17.14 | $19.69 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.94 / $20.32 / $23.72
| Professional | | $16.94 | $20.32 | $23.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.95 / $18.30 / $25.94
| Professional | | $13.95 | $18.30 | $25.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.80 / $15.54 / $21.20
| Professional | | $12.80 | $15.54 | $21.20 |