- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.62 / $11.02 / $15.14
| Professional | | $6.62 | $11.02 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.91 / $10.91 / $10.91
| Professional | | $10.91 | $10.91 | $10.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $10.46 / $10.46
| Professional | | $10.46 | $10.46 | $10.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.14 / $13.24 / $15.45
| Professional | | $12.14 | $13.24 | $15.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.62 / $13.11 / $14.79
| Professional | | $11.62 | $13.11 | $14.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $21.06 / $27.75
| Professional | | $17.89 | $21.06 | $27.75 |