- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.91 / $10.72 / $23.44
| Facility | | $8.91 | $10.72 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $10.00 / $15.14
| Professional | | $7.94 | $10.00 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $18.62
| Professional | | $12.88 | $12.88 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $26.30 / $28.18
| Professional | | $18.62 | $26.30 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $12.88 / $20.89
| Professional | | $10.72 | $12.88 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $15.14 / $20.89
| Professional | | $4.47 | $15.14 | $20.89 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $19.50 / $26.92
| Professional | | $10.72 | $19.50 | $26.92 |