- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.62 / $12.03 / $15.44
| Facility | | $10.62 | $12.03 | $15.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.14 / $14.16 / $27.46
| Professional | | $11.14 | $14.16 | $27.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $10.21 / $10.21
| Professional | | $10.21 | $10.21 | $10.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.93 / $27.59 / $32.29
| Professional | | $20.93 | $27.59 | $32.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $15.44 / $19.30
| Professional | | $12.87 | $15.44 | $19.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $15.44 / $24.98
| Professional | | $7.72 | $15.44 | $24.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.89 / $22.25 / $25.59
| Professional | | $18.89 | $22.25 | $25.59 |