- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.17 / $12.66 / $16.25
| Facility | | $11.17 | $12.66 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $15.82 / $96.00
| Professional | | $15.66 | $15.82 | $96.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $16.25 / $16.25
| Professional | | $10.80 | $16.25 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.05 / $29.09 / $34.01
| Professional | | $22.05 | $29.09 | $34.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.54 / $16.25 / $20.30
| Professional | | $13.54 | $16.25 | $20.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $16.25 / $26.31
| Professional | | $5.69 | $16.25 | $26.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.16 / $24.61 / $34.07
| Professional | | $15.16 | $24.61 | $34.07 |