- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.94 / $9.55 / $11.75
| Facility | | $7.94 | $9.55 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $8.71 / $8.91
| Professional | | $7.08 | $8.71 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $7.59 / $11.75
| Professional | | $7.59 | $7.59 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $21.38 / $23.99
| Professional | | $16.60 | $21.38 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $11.75 / $14.45
| Professional | | $9.77 | $11.75 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $13.49 / $19.05
| Professional | | $4.07 | $13.49 | $19.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $17.38 / $24.55
| Professional | | $10.96 | $17.38 | $24.55 |