- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $8.68 / $17.76
| Professional | | $7.75 | $8.68 | $17.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.40 / $8.41 / $13.88
| Professional | | $6.40 | $8.41 | $13.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.69 / $2.23 / $12.30
| Professional | | $1.69 | $2.23 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.89 / $10.02 / $22.62
| Professional | | $7.89 | $10.02 | $22.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $15.66 / $17.28
| Professional | | $9.44 | $15.66 | $17.28 |