- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.04 / $14.44 / $19.98
| Facility | | $12.04 | $14.44 | $19.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.71 / $16.05 / $17.51
| Professional | | $12.71 | $16.05 | $17.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $17.51 / $17.51
| Professional | | $11.58 | $17.51 | $17.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.71 / $31.27 / $36.61
| Professional | | $23.71 | $31.27 | $36.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.59 / $17.51 / $20.43
| Professional | | $14.59 | $17.51 | $20.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.13 / $17.51 / $28.31
| Professional | | $6.13 | $17.51 | $28.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.59 / $26.29 / $36.68
| Professional | | $14.59 | $26.29 | $36.68 |