- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.11 / $14.86 / $19.07
| Facility | | $13.11 | $14.86 | $19.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.89 / $15.89 / $15.89
| Professional | | $15.89 | $15.89 | $15.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $19.07 / $19.07
| Professional | | $10.21 | $19.07 | $19.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.97 / $27.66 / $32.36
| Professional | | $20.97 | $27.66 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.89 / $19.07 / $23.84
| Professional | | $15.89 | $19.07 | $23.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $19.07 / $25.01
| Professional | | $6.67 | $19.07 | $25.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.80 / $23.41 / $33.32
| Professional | | $17.80 | $23.41 | $33.32 |