- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.48 / $15.28 / $19.61
| Facility | | $13.48 | $15.28 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.66 / $8.66 / $16.32
| Professional | | $8.66 | $8.66 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.96 / $19.61 / $19.61
| Professional | | $12.96 | $19.61 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.58 / $35.04 / $41.01
| Professional | | $26.58 | $35.04 | $41.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.34 / $19.61 / $24.51
| Professional | | $16.34 | $19.61 | $24.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.86 / $19.61 / $31.72
| Professional | | $6.86 | $19.61 | $31.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.30 / $29.68 / $41.09
| Professional | | $18.30 | $29.68 | $41.09 |