- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.20 / $18.11 / $18.72
| Professional | | $13.20 | $18.11 | $18.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.96 / $16.03 / $21.71
| Professional | | $11.96 | $16.03 | $21.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.55 / $57.60 / $60.31
| Professional | | $14.55 | $57.60 | $60.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.11 / $19.11 / $24.32
| Professional | | $19.11 | $19.11 | $24.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.82 / $14.82 / $18.86
| Professional | 26 | $14.82 | $14.82 | $18.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $21.71 / $31.54
| Professional | | $16.50 | $21.71 | $31.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.81 / $20.86 / $43.94
| Professional | | $12.81 | $20.86 | $43.94 |