- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.22 / $12.41 / $16.55
| Professional | | $3.22 | $12.41 | $16.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.80 / $11.00 / $18.21
| Professional | | $2.80 | $11.00 | $18.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.34 / $15.13 / $18.09
| Professional | | $11.34 | $15.13 | $18.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $14.81 / $17.48
| Professional | | $8.00 | $14.81 | $17.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $14.47 / $19.91
| Professional | | $5.75 | $14.47 | $19.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $13.03 / $17.63
| Professional | | $13.03 | $13.03 | $17.63 |