- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.28 / $10.53 / $13.51
| Facility | | $9.28 | $10.53 | $13.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.26 / $12.39 / $29.51
| Professional | | $11.26 | $12.39 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.83 / $13.51 / $13.51
| Professional | | $8.83 | $13.51 | $13.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.32 / $24.18 / $28.27
| Professional | | $18.32 | $24.18 | $28.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.26 / $13.51 / $16.89
| Professional | | $11.26 | $13.51 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.73 / $13.51 / $21.85
| Professional | | $4.73 | $13.51 | $21.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.26 / $20.29 / $28.31
| Professional | | $11.26 | $20.29 | $28.31 |