- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $14.45 / $17.38
| Facility | | $12.02 | $14.45 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $12.02 / $14.13
| Professional | | $7.94 | $12.02 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.23 / $17.38
| Professional | | $10.23 | $10.23 | $17.38 |
- 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
- $14.45 / $17.38 / $21.88
| Professional | | $14.45 | $17.38 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $17.78 / $25.12
| Professional | | $6.03 | $17.78 | $25.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $23.44 / $32.36
| Professional | | $16.22 | $23.44 | $32.36 |