- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.11 / $11.45 / $14.70
| Facility | | $10.11 | $11.45 | $14.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $16.82
| Professional | | $10.74 | $10.74 | $16.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.70 / $14.70
| Professional | | $9.42 | $14.70 | $14.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.73 / $30.11
| Professional | | $19.51 | $25.73 | $30.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $14.70 / $18.38
| Professional | | $12.25 | $14.70 | $18.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.15 / $14.70 / $23.27
| Professional | | $5.15 | $14.70 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.72 / $21.79 / $30.17
| Professional | | $13.72 | $21.79 | $30.17 |