- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $12.59 / $15.49
| Facility | | $10.47 | $12.59 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $11.48 / $12.02
| Professional | | $6.03 | $11.48 | $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
- $21.88 / $28.18 / $31.62
| Professional | | $21.88 | $28.18 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.49 / $19.05
| Professional | | $12.88 | $15.49 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $17.78 / $25.12
| Professional | | $5.37 | $17.78 | $25.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $22.91 / $32.36
| Professional | | $14.45 | $22.91 | $32.36 |