- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.94 / $11.27 / $14.46
| Facility | | $9.94 | $11.27 | $14.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $14.41 / $17.60
| Professional | | $10.74 | $14.41 | $17.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $9.61 / $9.61
| Professional | | $9.61 | $9.61 | $9.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.60 / $25.85 / $30.24
| Professional | | $19.60 | $25.85 | $30.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $14.46 / $16.87
| Professional | | $12.05 | $14.46 | $16.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $14.46 / $23.38
| Professional | | $5.05 | $14.46 | $23.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.57 / $23.32 / $29.47
| Professional | | $22.57 | $23.32 | $29.47 |