- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $26.92 / $54.95
| Professional | | $15.85 | $26.92 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $15.49 / $18.20
| Professional | | $12.59 | $15.49 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $16.22 / $18.62
| Professional | | $13.49 | $16.22 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $19.95 / $28.84
| Professional | | $7.94 | $19.95 | $28.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $12.88 / $15.14
| Professional | | $10.47 | $12.88 | $15.14 |