- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.00 / $9.07 / $11.64
| Facility | | $8.00 | $9.07 | $11.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.64 / $8.78 / $9.69
| Professional | | $8.64 | $8.78 | $9.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $11.64 / $11.64
| Professional | | $7.66 | $11.64 | $11.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.79 / $20.83 / $24.39
| Professional | | $15.79 | $20.83 | $24.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.69 / $11.64 / $14.55
| Professional | | $9.69 | $11.64 | $14.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $11.64 / $18.82
| Professional | | $4.07 | $11.64 | $18.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.86 / $17.62 / $24.39
| Professional | | $10.86 | $17.62 | $24.39 |