- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.33 / $12.84 / $16.48
| Facility | | $11.33 | $12.84 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $11.97 / $86.09
| Professional | | $11.97 | $11.97 | $86.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $16.48 / $16.48
| Professional | | $10.80 | $16.48 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.28 / $29.40 / $34.39
| Professional | | $22.28 | $29.40 | $34.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.73 / $16.48 / $20.60
| Professional | | $13.73 | $16.48 | $20.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $16.48 / $26.66
| Professional | | $5.77 | $16.48 | $26.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.38 / $24.73 / $34.51
| Professional | | $15.38 | $24.73 | $34.51 |