- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $7.79 / $13.16
| Professional | | $6.76 | $7.79 | $13.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $7.28 / $11.91
| Professional | | $5.56 | $7.28 | $11.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $10.37 / $12.38
| Professional | | $9.03 | $10.37 | $12.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.65 / $7.82 / $9.13
| Professional | | $6.65 | $7.82 | $9.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.65 / $8.15 / $19.92
| Professional | | $6.65 | $8.15 | $19.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $8.33 / $14.56
| Professional | | $6.00 | $8.33 | $14.56 |