- 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 / $12.02
| Professional | | $8.91 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.23 / $15.49
| Professional | | $10.23 | $10.23 | $15.49 |
- 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 / $19.50
| Professional | | $12.88 | $15.49 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $18.20 / $25.12
| Professional | | $5.37 | $18.20 | $25.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $23.44 / $32.36
| Professional | | $14.45 | $23.44 | $32.36 |