- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.81 / $11.12 / $14.27
| Facility | | $9.81 | $11.12 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.27 / $14.27
| Professional | | $9.42 | $14.27 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.37 / $25.55 / $29.86
| Professional | | $19.37 | $25.55 | $29.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.89 / $14.27 / $17.84
| Professional | | $11.89 | $14.27 | $17.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.99 / $14.27 / $23.09
| Professional | | $4.99 | $14.27 | $23.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.32 / $21.61 / $29.92
| Professional | | $13.32 | $21.61 | $29.92 |