- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.91 / $16.78 / $19.27
| Professional | | $10.91 | $16.78 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.90 / $10.91 / $13.10
| Professional | | $8.90 | $10.91 | $13.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.97 / $66.70 / $87.39
| Professional | | $57.97 | $66.70 | $87.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.90 / $10.48 / $12.22
| Professional | | $8.90 | $10.48 | $12.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.57 / $10.91 / $45.25
| Professional | | $8.57 | $10.91 | $45.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.27 / $12.07 / $56.11
| Professional | | $8.27 | $12.07 | $56.11 |