- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.74 / $11.04 / $12.99
| Facility | | $9.74 | $11.04 | $12.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.65 / $10.45 / $10.45
| Professional | | $8.65 | $10.45 | $10.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.16 / $11.16 / $11.16
| Facility | | $11.16 | $11.16 | $11.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $12.30 / $14.43
| Professional | | $11.04 | $12.30 | $14.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $13.77 / $16.44
| Professional | | $12.00 | $13.77 | $16.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.58 / $11.54 / $13.47
| Professional | | $10.58 | $11.54 | $13.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.10 / $12.99 / $16.82
| Professional | | $6.10 | $12.99 | $16.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.16 / $14.29 / $17.36
| Professional | | $9.16 | $14.29 | $17.36 |