- 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
- $6.03 / $8.91 / $10.96
| Professional | | $6.03 | $8.91 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $6.61 / $14.13
| Professional | | $6.61 | $6.61 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $18.62 / $20.42
| Professional | | $14.45 | $18.62 | $20.42 |
- 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
- $4.90 / $14.13 / $17.78
| Professional | | $4.90 | $14.13 | $17.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $15.85 / $21.88
| Professional | | $12.30 | $15.85 | $21.88 |