- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.18 / $15.85 / $19.05
| Facility | | $13.18 | $15.85 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.14 / $15.14
| Professional | | $10.96 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $19.05
| Professional | | $12.88 | $12.88 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $35.48 / $38.90
| Professional | | $27.54 | $35.48 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $19.05 / $23.99
| Professional | | $15.85 | $19.05 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $22.39 / $30.90
| Professional | | $6.76 | $22.39 | $30.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $28.84 / $39.81
| Professional | | $17.78 | $28.84 | $39.81 |