- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.78 / $9.41 / $37.92
| Professional | | $7.78 | $9.41 | $37.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.68 / $8.77 / $13.66
| Professional | | $6.68 | $8.77 | $13.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.85 / $11.31 / $13.50
| Professional | | $9.85 | $11.31 | $13.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.07 / $9.49 / $11.07
| Professional | | $8.07 | $9.49 | $11.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.07 / $9.89 / $23.70
| Professional | | $8.07 | $9.89 | $23.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.22 / $11.01 / $17.64
| Professional | | $6.22 | $11.01 | $17.64 |