- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $11.73 / $14.22
| Facility | | $9.77 | $11.73 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.67 / $10.67 / $74.30
| Professional | | $10.67 | $10.67 | $74.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.22 / $14.22
| Professional | | $9.42 | $14.22 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.27 / $25.43 / $29.73
| Professional | | $19.27 | $25.43 | $29.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.85 / $14.22 / $17.78
| Professional | | $11.85 | $14.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.98 / $14.22 / $23.01
| Professional | | $4.98 | $14.22 | $23.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.27 / $21.52 / $29.79
| Professional | | $13.27 | $21.52 | $29.79 |