- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $9.77 / $11.75
| Facility | | $8.13 | $9.77 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.08 / $8.91
| Professional | | $5.01 | $7.08 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $6.03 / $11.75
| Professional | | $6.03 | $6.03 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $16.98 / $19.05
| Professional | | $13.18 | $16.98 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $11.75 / $14.79
| Professional | | $9.77 | $11.75 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $11.75 / $14.79
| Professional | | $4.07 | $11.75 | $14.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $14.13 / $19.95
| Professional | | $10.96 | $14.13 | $19.95 |