- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.92 / $12.38 / $15.89
| Facility | | $10.92 | $12.38 | $15.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.47 / $15.47 / $15.47
| Professional | | $15.47 | $15.47 | $15.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $15.89 / $15.89
| Professional | | $10.40 | $15.89 | $15.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.54 / $28.41 / $33.22
| Professional | | $21.54 | $28.41 | $33.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.24 / $15.89 / $19.86
| Professional | | $13.24 | $15.89 | $19.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $15.89 / $25.71
| Professional | | $5.56 | $15.89 | $25.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.83 / $24.06 / $33.32
| Professional | | $14.83 | $24.06 | $33.32 |