- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.40 / $10.65 / $13.67
| Facility | | $9.40 | $10.65 | $13.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $9.92 / $10.33
| Professional | | $9.77 | $9.92 | $10.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $13.67 / $13.67
| Professional | | $9.02 | $13.67 | $13.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.52 / $24.43 / $28.60
| Professional | | $18.52 | $24.43 | $28.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $13.67 / $17.09
| Professional | | $11.39 | $13.67 | $17.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.78 / $13.67 / $22.10
| Professional | | $4.78 | $13.67 | $22.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.76 / $20.68 / $28.64
| Professional | | $12.76 | $20.68 | $28.64 |