- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.80 / $8.85 / $11.35
| Facility | | $7.80 | $8.85 | $11.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.41 / $10.41 / $59.31
| Professional | | $10.41 | $10.41 | $59.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $11.35 / $11.35
| Professional | | $7.46 | $11.35 | $11.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.36 / $20.26 / $23.70
| Professional | | $15.36 | $20.26 | $23.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.46 / $11.35 / $14.19
| Professional | | $9.46 | $11.35 | $14.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.97 / $11.35 / $18.35
| Professional | | $3.97 | $11.35 | $18.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.60 / $17.16 / $23.76
| Professional | | $10.60 | $17.16 | $23.76 |