- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $8.91 / $14.13
| Professional | | $5.01 | $8.91 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $9.33 / $12.30
| Professional | | $5.37 | $9.33 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $70.79 / $81.28
| Professional | | $61.66 | $70.79 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $18.62
| Professional | | $13.80 | $13.80 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.68 / $11.75 / $20.42
| Professional | | $4.68 | $11.75 | $20.42 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $10.47 / $51.29
| Professional | | $8.51 | $10.47 | $51.29 |