- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.24 / $11.60 / $14.89
| Facility | | $10.24 | $11.60 | $14.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.08 / $11.23 / $11.24
| Professional | | $11.08 | $11.23 | $11.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.82 / $14.89 / $14.89
| Professional | | $9.82 | $14.89 | $14.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.17 / $26.60 / $31.17
| Professional | | $20.17 | $26.60 | $31.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.41 / $14.89 / $18.62
| Professional | | $12.41 | $14.89 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.21 / $14.89 / $24.08
| Professional | | $5.21 | $14.89 | $24.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.90 / $22.54 / $31.21
| Professional | | $13.90 | $22.54 | $31.21 |