- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $18.09 / $77.33
| Professional | | $13.45 | $18.09 | $77.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.24 / $16.03 / $26.30
| Professional | | $12.24 | $16.03 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.03 / $19.57 / $25.71
| Professional | | $17.03 | $19.57 | $25.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.08 / $15.38 / $17.95
| Professional | | $13.08 | $15.38 | $17.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.08 / $16.03 / $27.60
| Professional | | $13.08 | $16.03 | $27.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $19.82 / $42.61
| Professional | | $12.17 | $19.82 | $42.61 |