- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.68 / $3.06 / $7.09
| Professional | | $2.68 | $3.06 | $7.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.11 / $11.42 / $11.42
| Professional | | $5.11 | $11.42 | $11.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $10.87 / $10.87
| Professional | | $10.38 | $10.87 | $10.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.53 / $14.53 / $14.53
| Professional | | $14.53 | $14.53 | $14.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.32 / $10.28 / $12.95
| Professional | | $3.32 | $10.28 | $12.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.09 / $8.65 / $9.88
| Professional | | $7.09 | $8.65 | $9.88 |