- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.38 / $18.45 / $22.37
| Facility | | $15.38 | $18.45 | $22.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.47 / $15.47 / $15.47
| Professional | | $15.47 | $15.47 | $15.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $22.37 / $22.37
| Professional | | $10.40 | $22.37 | $22.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $26.72 / $32.53
| Professional | | $21.05 | $26.72 | $32.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $22.37 / $27.96
| Professional | | $18.64 | $22.37 | $27.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $22.37 / $27.96
| Professional | | $7.83 | $22.37 | $27.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.84 / $25.16 / $41.94
| Professional | | $15.84 | $25.16 | $41.94 |