- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $6.64 / $14.98
| Professional | | $4.07 | $6.64 | $14.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.58 / $7.79 / $66.00
| Professional | | $5.58 | $7.79 | $66.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.07 / $5.76 / $6.78
| Professional | | $5.07 | $5.76 | $6.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.33 / $8.43 / $9.16
| Professional | | $7.33 | $8.43 | $9.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $7.48 / $10.43
| Professional | | $5.77 | $7.48 | $10.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $9.16 / $250.00
| Professional | | $5.00 | $9.16 | $250.00 |