- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.42 / $12.94 / $16.61
| Facility | | $11.42 | $12.94 | $16.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $11.97 / $86.78
| Professional | | $11.97 | $11.97 | $86.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.99 / $16.61 / $16.61
| Professional | | $10.99 | $16.61 | $16.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.47 / $29.65 / $34.74
| Professional | | $22.47 | $29.65 | $34.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.84 / $16.61 / $20.76
| Professional | | $13.84 | $16.61 | $20.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $16.61 / $26.85
| Professional | | $5.81 | $16.61 | $26.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.84 / $24.92 / $34.78
| Professional | | $13.84 | $24.92 | $34.78 |