- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $11.75 / $14.13
| Facility | | $9.77 | $11.75 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $8.91 / $10.96
| Professional | | $3.98 | $8.91 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $9.33 / $14.13
| Professional | | $9.33 | $9.33 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $26.30 / $29.51
| Professional | | $20.42 | $26.30 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $14.13 / $17.78
| Professional | | $11.75 | $14.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $16.60 / $22.91
| Professional | | $5.01 | $16.60 | $22.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $21.38 / $29.51
| Professional | | $13.18 | $21.38 | $29.51 |