- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.97 / $11.30 / $14.51
| Facility | | $9.97 | $11.30 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $7.82 / $7.82
| Professional | | $7.82 | $7.82 | $7.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $14.51 / $14.51
| Professional | | $8.05 | $14.51 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.64 / $11.01 / $12.66
| Professional | | $9.64 | $11.01 | $12.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.30 / $14.51 / $16.93
| Professional | | $13.30 | $14.51 | $16.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $14.51 / $18.25
| Professional | | $8.71 | $14.51 | $18.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.82 / $10.28 / $17.77
| Professional | | $6.82 | $10.28 | $17.77 |