- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $12.88 / $17.78
| Facility | | $10.72 | $12.88 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $11.75 / $14.45
| Professional | | $9.77 | $11.75 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $15.49
| Professional | | $10.47 | $10.47 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $28.84 / $32.36
| Professional | | $22.39 | $28.84 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $15.49 / $19.50
| Professional | | $13.18 | $15.49 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $18.20 / $25.12
| Professional | | $5.50 | $18.20 | $25.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $23.44 / $33.11
| Professional | | $14.45 | $23.44 | $33.11 |