- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.46 / $10.72 / $13.76
| Facility | | $9.46 | $10.72 | $13.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.25 / $13.40
| Professional | | $10.00 | $10.25 | $13.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $13.76 / $13.76
| Professional | | $9.02 | $13.76 | $13.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.66 / $24.61 / $28.79
| Professional | | $18.66 | $24.61 | $28.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.47 / $13.76 / $17.21
| Professional | | $11.47 | $13.76 | $17.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.82 / $13.76 / $22.27
| Professional | | $4.82 | $13.76 | $22.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.85 / $20.84 / $28.85
| Professional | | $12.85 | $20.84 | $28.85 |