- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.18 / $14.26 / $22.16
| Professional | | $12.18 | $14.26 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $14.75 / $23.17
| Professional | | $10.01 | $14.75 | $23.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.16 / $18.53 / $22.13
| Professional | | $16.16 | $18.53 | $22.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.04 / $16.51 / $19.26
| Professional | | $14.04 | $16.51 | $19.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.38 / $17.20 / $32.50
| Professional | | $12.38 | $17.20 | $32.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.42 / $15.77 / $27.38
| Professional | | $11.42 | $15.77 | $27.38 |