- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.52 / $10.79 / $13.85
| Facility | | $9.52 | $10.79 | $13.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $11.90 / $15.84
| Professional | | $11.78 | $11.90 | $15.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $13.85 / $13.85
| Professional | | $8.05 | $13.85 | $13.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.59 / $21.88 / $25.57
| Professional | | $16.59 | $21.88 | $25.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $13.85 / $16.16
| Professional | | $11.54 | $13.85 | $16.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.85 / $13.85 / $17.30
| Professional | | $13.85 | $13.85 | $17.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.92 / $18.51 / $25.97
| Professional | | $12.92 | $18.51 | $25.97 |