- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $12.59 / $15.14
| Facility | | $10.47 | $12.59 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $10.00 / $12.02
| Professional | | $7.94 | $10.00 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $15.14
| Professional | | $8.91 | $8.91 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $24.55 / $26.92
| Professional | | $19.05 | $24.55 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $15.14 / $19.05
| Professional | | $12.59 | $15.14 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $15.49 / $21.38
| Professional | | $5.37 | $15.49 | $21.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $19.95 / $28.18
| Professional | | $14.13 | $19.95 | $28.18 |