- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.91 / $11.23 / $14.41
| Facility | | $9.91 | $11.23 | $14.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.37 / $6.37 / $12.00
| Professional | | $6.37 | $6.37 | $12.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.41 / $14.41
| Professional | | $9.42 | $14.41 | $14.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.73 / $30.11
| Professional | | $19.51 | $25.73 | $30.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.01 / $14.41 / $18.02
| Professional | | $12.01 | $14.41 | $18.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.41 / $14.41 / $18.02
| Professional | | $14.41 | $14.41 | $18.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $21.81 / $30.20
| Professional | | $13.45 | $21.81 | $30.20 |