- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.64 / $12.77 / $15.48
| Facility | | $10.64 | $12.77 | $15.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.08 / $11.21 / $14.90
| Professional | | $11.08 | $11.21 | $14.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.48 / $15.48
| Professional | | $10.21 | $15.48 | $15.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.47 / $17.77 / $20.81
| Professional | | $13.47 | $17.77 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.90 / $15.48 / $19.35
| Professional | | $12.90 | $15.48 | $19.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $15.48 / $19.35
| Professional | | $5.42 | $15.48 | $19.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.15 / $16.02 / $27.61
| Professional | | $12.15 | $16.02 | $27.61 |