- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.78 / $10.35 / $17.18
| Professional | | $8.78 | $10.35 | $17.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.33 / $20.21 / $23.30
| Professional | | $11.33 | $20.21 | $23.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.94 / $17.43 / $26.10
| Professional | | $13.94 | $17.43 | $26.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.33 / $20.50 / $23.30
| Professional | | $10.33 | $20.50 | $23.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.01 / $21.19 / $27.50
| Professional | | $19.01 | $21.19 | $27.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.90 / $16.30 / $29.27
| Professional | | $7.90 | $16.30 | $29.27 |