- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.98 / $21.48 / $25.22
| Professional | | $7.98 | $21.48 | $25.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.41 / $11.89 / $11.89
| Professional | | $4.41 | $11.89 | $11.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $11.32 / $11.32
| Professional | | $10.81 | $11.32 | $11.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.13 / $15.13 / $15.13
| Professional | | $15.13 | $15.13 | $15.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.58 / $11.89 / $46.84
| Professional | | $4.58 | $11.89 | $46.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.44 / $9.07 / $13.94
| Professional | | $4.44 | $9.07 | $13.94 |