- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $2.40 / $5.31
| Professional | | $2.10 | $2.40 | $5.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.04 / $8.61 / $8.61
| Professional | | $3.04 | $8.61 | $8.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.84 / $8.21 / $8.21
| Professional | | $7.84 | $8.21 | $8.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $10.98 / $10.98
| Professional | | $10.98 | $10.98 | $10.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $7.76 / $9.80
| Professional | | $2.61 | $7.76 | $9.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $6.54 / $7.47
| Professional | | $6.32 | $6.54 | $7.47 |