- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.78 / $5.46 / $13.07
| Professional | | $4.78 | $5.46 | $13.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.28 / $19.61 / $19.61
| Professional | | $7.28 | $19.61 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.82 / $18.67 / $18.67
| Professional | | $17.82 | $18.67 | $18.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.96 / $24.96 / $24.96
| Professional | | $24.96 | $24.96 | $24.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.92 / $16.67 / $22.23
| Professional | | $5.92 | $16.67 | $22.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.36 / $14.85 / $16.97
| Professional | | $14.36 | $14.85 | $16.97 |