- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.69 / $14.29 / $50.75
| Professional | | $9.69 | $14.29 | $50.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.98 / $18.93 / $50.37
| Professional | | $14.98 | $18.93 | $50.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.48 / $17.04 / $20.02
| Professional | | $14.48 | $17.04 | $20.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.79 / $16.64 / $21.20
| Professional | | $13.79 | $16.64 | $21.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.95 / $18.93 / $24.23
| Professional | | $13.95 | $18.93 | $24.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.54 / $17.84 / $18.48
| Professional | | $13.54 | $17.84 | $18.48 |