- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.21 / $6.59 / $7.24
| Professional | | $6.21 | $6.59 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.44 / $9.26 / $9.26
| Professional | | $3.44 | $9.26 | $9.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.42 / $8.82 / $8.82
| Professional | | $8.42 | $8.82 | $8.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.79 / $11.79 / $11.79
| Professional | | $11.79 | $11.79 | $11.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $9.26 / $10.50
| Professional | | $4.20 | $9.26 | $10.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.46 / $7.06 / $10.86
| Professional | | $3.46 | $7.06 | $10.86 |