- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.45 / $20.37 / $20.51
| Professional | | $15.45 | $20.37 | $20.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $11.24 / $56.34
| Professional | | $11.24 | $11.24 | $56.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.22 / $53.63 / $53.63
| Professional | | $51.22 | $53.63 | $53.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.70 / $71.70 / $71.70
| Professional | | $71.70 | $71.70 | $71.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.15 / $16.05 / $63.87
| Professional | | $9.15 | $16.05 | $63.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.67 / $44.85 / $48.75
| Professional | | $42.67 | $44.85 | $48.75 |