- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $12.88 / $15.49
| Facility | | $10.72 | $12.88 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.02 / $27.54
| Professional | | $8.91 | $12.02 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.23 / $10.23
| Professional | | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $28.84 / $31.62
| Professional | | $22.39 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.49 / $20.89
| Professional | | $12.88 | $15.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $17.78 / $25.12
| Professional | | $7.76 | $17.78 | $25.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $22.39 / $25.70
| Professional | | $19.05 | $22.39 | $25.70 |