- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $13.18 / $15.85
| Facility | | $10.96 | $13.18 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $10.00 / $12.02
| Professional | | $7.08 | $10.00 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $7.76 / $15.85
| Professional | | $7.76 | $7.76 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $20.89 / $22.91
| Professional | | $16.22 | $20.89 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $15.85 / $19.95
| Professional | | $13.49 | $15.85 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $15.85 / $19.95
| Professional | | $5.62 | $15.85 | $19.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $17.38 / $23.99
| Professional | | $13.80 | $17.38 | $23.99 |