- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.12 / $10.96 / $13.18
| Facility | | $9.12 | $10.96 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.94 / $10.00
| Professional | | $6.03 | $7.94 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $6.61 / $13.18
| Professional | | $6.61 | $6.61 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $18.62 / $20.89
| Professional | | $14.45 | $18.62 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $13.18 / $16.60
| Professional | | $10.96 | $13.18 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.57 / $13.18 / $16.60
| Professional | | $4.57 | $13.18 | $16.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $15.49 / $21.88
| Professional | | $12.30 | $15.49 | $21.88 |