- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.46 / $11.86 / $15.22
| Facility | | $10.46 | $11.86 | $15.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $11.53 / $11.53
| Professional | | $11.53 | $11.53 | $11.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $15.22 / $15.22
| Professional | | $10.01 | $15.22 | $15.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.64 / $27.22 / $31.89
| Professional | | $20.64 | $27.22 | $31.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.68 / $15.22 / $19.02
| Professional | | $12.68 | $15.22 | $19.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.33 / $15.22 / $24.62
| Professional | | $5.33 | $15.22 | $24.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.20 / $23.06 / $31.93
| Professional | | $14.20 | $23.06 | $31.93 |