- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $11.75 / $14.45
| Facility | | $9.77 | $11.75 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $10.00 / $10.96
| Professional | | $6.03 | $10.00 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $9.33 / $14.45
| Professional | | $9.33 | $9.33 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $21.38 / $23.99
| Professional | | $16.60 | $21.38 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $14.45 / $17.78
| Professional | | $12.02 | $14.45 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $16.60 / $23.44
| Professional | | $5.01 | $16.60 | $23.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $18.62 / $30.20
| Professional | | $10.23 | $18.62 | $30.20 |