- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.81 / $13.39 / $17.18
| Facility | | $11.81 | $13.39 | $17.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $11.56 / $19.66
| Professional | | $11.54 | $11.56 | $19.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $17.18 / $17.18
| Professional | | $10.21 | $17.18 | $17.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.89 / $25.26 / $30.74
| Professional | | $19.89 | $25.26 | $30.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $17.18 / $21.48
| Professional | | $14.32 | $17.18 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $17.18 / $25.12
| Professional | | $6.01 | $17.18 | $25.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $21.05 / $32.22
| Professional | | $12.17 | $21.05 | $32.22 |