- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.23 / $17.46 / $17.91
| Professional | | $8.23 | $17.46 | $17.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.57 / $9.57 / $16.59
| Professional | | $9.57 | $9.57 | $16.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.08 / $15.79 / $15.79
| Professional | | $15.08 | $15.79 | $15.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.11 / $21.11 / $21.11
| Professional | | $21.11 | $21.11 | $21.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.79 / $11.96 / $18.80
| Professional | | $7.79 | $11.96 | $18.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.57 / $13.21 / $14.36
| Professional | | $12.57 | $13.21 | $14.36 |