- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $12.82 / $15.54
| Facility | | $10.68 | $12.82 | $15.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.20 / $11.54 / $39.00
| Professional | | $11.20 | $11.54 | $39.00 |
- 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
- $21.06 / $27.79 / $30.91
| Professional | | $21.06 | $27.79 | $30.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $15.54 / $19.43
| Professional | | $12.95 | $15.54 | $19.43 |
- 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
- $12.95 / $23.52 / $32.56
| Professional | | $12.95 | $23.52 | $32.56 |