- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.48 / $11.87 / $15.24
| Facility | | $10.48 | $11.87 | $15.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.60 / $11.60 / $17.44
| Professional | | $11.60 | $11.60 | $17.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $15.24 / $15.24
| Professional | | $8.05 | $15.24 | $15.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $21.50 / $25.15
| Professional | | $16.30 | $21.50 | $25.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.70 / $15.24 / $19.05
| Professional | | $12.70 | $15.24 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.62 / $15.24 / $19.47
| Professional | | $7.62 | $15.24 | $19.47 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $18.47 / $25.94
| Professional | | $14.22 | $18.47 | $25.94 |