- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $13.18 / $15.85
| Facility | | $10.96 | $13.18 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.02 / $12.02
| Professional | | $8.91 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $15.85
| Professional | | $10.00 | $10.00 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $29.51 / $32.36
| Professional | | $22.91 | $29.51 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $15.85 / $19.95
| Professional | | $13.18 | $15.85 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $18.20 / $25.70
| Professional | | $5.62 | $18.20 | $25.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $20.42 / $44.67
| Professional | | $11.22 | $20.42 | $44.67 |