- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $21.60 / $21.79
| Professional | | $10.48 | $21.60 | $21.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.23 / $9.23 / $39.44
| Professional | | $9.23 | $9.23 | $39.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.85 / $37.54 / $37.54
| Professional | | $35.85 | $37.54 | $37.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.19 / $50.19 / $50.19
| Professional | | $50.19 | $50.19 | $50.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.51 / $13.33 / $44.72
| Professional | | $7.51 | $13.33 | $44.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.87 / $31.39 / $34.11
| Professional | | $29.87 | $31.39 | $34.11 |