- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $12.11 / $15.54
| Facility | | $10.68 | $12.11 | $15.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $11.75 / $20.48
| Professional | | $11.54 | $11.75 | $20.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.54 / $15.54
| Professional | | $10.21 | $15.54 | $15.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.35 / $24.59 / $32.49
| Professional | | $22.35 | $24.59 | $32.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $15.54 / $18.13
| Professional | | $12.95 | $15.54 | $18.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $15.54 / $25.12
| Professional | | $5.44 | $15.54 | $25.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.28 / $24.24 / $33.47
| Professional | | $15.28 | $24.24 | $33.47 |