- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.64 / $15.17 / $18.38
| Facility | | $12.64 | $15.17 | $18.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.26 / $13.26 / $21.03
| Professional | | $13.26 | $13.26 | $21.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $18.38 / $18.38
| Professional | | $12.17 | $18.38 | $18.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.93 / $32.88 / $38.45
| Professional | | $24.93 | $32.88 | $38.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.32 / $18.38 / $22.98
| Professional | | $15.32 | $18.38 | $22.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $18.38 / $29.75
| Professional | | $6.43 | $18.38 | $29.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.16 / $27.83 / $38.54
| Professional | | $17.16 | $27.83 | $38.54 |