- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.28 / $18.32 / $22.22
| Facility | | $15.28 | $18.32 | $22.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $20.37 / $34.81
| Professional | | $12.30 | $20.37 | $34.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $22.22 / $22.22
| Professional | | $10.80 | $22.22 | $22.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.87 / $26.50 / $32.25
| Professional | | $20.87 | $26.50 | $32.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.52 / $22.22 / $26.78
| Professional | | $18.52 | $22.22 | $26.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.78 / $22.22 / $27.78
| Professional | | $7.78 | $22.22 | $27.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.74 / $27.22 / $35.15
| Professional | | $15.74 | $27.22 | $35.15 |