- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.40 / $15.84 / $16.54
| Professional | | $14.40 | $15.84 | $16.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.79 / $66.00 / $107.04
| Professional | | $20.79 | $66.00 | $107.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.36 / $22.77 / $28.58
| Professional | | $19.36 | $22.77 | $28.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.39 / $19.35 / $21.04
| Professional | | $17.39 | $19.35 | $21.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $18.41 / $30.05
| Professional | | $13.65 | $18.41 | $30.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.35 / $23.66 / $250.00
| Professional | | $16.35 | $23.66 | $250.00 |