- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.39 / $16.17 / $16.54
| Professional | | $13.39 | $16.17 | $16.54 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $6.70 / $8.09 / $8.27
| Professional | 52 | $6.70 | $8.09 | $8.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.24 / $14.79 / $18.93
| Professional | | $12.24 | $14.79 | $18.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $20.89 / $23.52
| Professional | | $18.20 | $20.89 | $23.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $16.64 / $21.20
| Professional | | $16.64 | $16.64 | $21.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.56 / $16.35 / $25.16
| Professional | | $14.56 | $16.35 | $25.16 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $17.25 / $23.85
| Professional | | $11.58 | $17.25 | $23.85 |