- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $15.49 / $18.62
| Facility | | $12.88 | $15.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $14.13 / $26.92
| Professional | | $10.96 | $14.13 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $12.30 / $18.62
| Professional | | $12.30 | $12.30 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $34.67 / $38.02
| Professional | | $26.92 | $34.67 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $18.62 / $23.44
| Professional | | $15.49 | $18.62 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $21.88 / $30.20
| Professional | | $6.46 | $21.88 | $30.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $28.18 / $38.90
| Professional | | $17.38 | $28.18 | $38.90 |