- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.96 / $3.00 / $41.17
| Professional | | $2.96 | $3.00 | $41.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $1.96 / $1.96
| Professional | | $1.96 | $1.96 | $1.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.54 / $6.79 / $31.39
| Professional | | $5.54 | $6.79 | $31.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.98 / $35.97 / $44.97
| Professional | | $29.98 | $35.97 | $44.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.59 / $35.97 / $44.97
| Professional | | $3.59 | $35.97 | $44.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.77 / $4.44 / $5.11
| Professional | | $3.77 | $4.44 | $5.11 |