- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.00 / $10.78 / $14.23
| Professional | | $9.00 | $10.78 | $14.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.21 / $17.73 / $19.73
| Professional | | $14.21 | $17.73 | $19.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.36 / $19.97 / $23.48
| Professional | | $17.36 | $19.97 | $23.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $17.37 / $20.05
| Professional | | $13.03 | $17.37 | $20.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.21 / $17.60 / $19.73
| Professional | | $14.21 | $17.60 | $19.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.30 / $15.15 / $15.42
| Professional | | $11.30 | $15.15 | $15.42 |