- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $15.49 / $19.05
| Facility | | $12.88 | $15.49 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $13.80 / $15.14
| Professional | | $5.01 | $13.80 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $12.59 / $19.05
| Professional | | $12.59 | $12.59 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $34.67 / $38.90
| Professional | | $26.92 | $34.67 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $19.05 / $23.44
| Professional | | $15.85 | $19.05 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $21.88 / $30.90
| Professional | | $6.61 | $21.88 | $30.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $27.54 / $39.81
| Professional | | $14.13 | $27.54 | $39.81 |